Mohs Micrographic Surgery prior authorization changes

Starting as early as Dec. 1, 2023, we’ll no longer require prior authorization for Mohs Micrographic Surgery for flap repair, including CPT® codes 14020, 14021 and 14061, when billed with a skin cancer diagnosis.

Affected plans

This affects the following UnitedHealthcare benefit plans:

• UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans, effective Dec. 1, 2023
• UnitedHealthcare Community Plans, effective Dec. 1, 2023
• UnitedHealthcare commercial plans, effective Jan. 1, 2024

Note: At this time, Individual Exchange plans and Community Plans in Ohio are excluded from this change and will continue to require prior authorization for CPT codes 14020, 14021 and 14061.

What you need to know

This change is part of our comprehensive effort to simplify the health care experience for our members and network health care professionals. While prior authorization remains an important tool to address clinical quality and safety, as well as fraud, waste and abuse, we also know that fewer prior authorizations can help streamline care delivery. 

Resources

• For more information about the Mohs Micrographic Surgery prior authorization/advanced notification program, please see our Advance Notification and Clinical Submission Requirements

CPT^® is a registered trademark of the American Medical Association.  

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