Improvements to prior authorization process for sacral nerve stimulation for urinary and fecal indications

Affects UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans

Beginning Oct. 1, we’re improving the prior authorization process for sacral nerve stimulation for urinary and fecal indications. The streamlined process will include both a site of service and medical necessity review for phase 1 (CPT® codes 64561 and 64581). We will no longer require a medical necessity review stage 2 in the process (CPT code 64590), and instead will only require a site of service review.

This affects UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.

Prior authorization

We require prior authorization for sacral nerve stimulation for urinary and fecal indications according to our sacral nerve stimulation for urinary and fecal indications medical policy.

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

• From any page on UHCprovider.com, select Sign In at the top-right corner
  — Enter your One Healthcare ID 
• New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
• From the left-hand tabs, select Prior Authorizations & Notifications. Then, click Create a new request.
• Select the appropriate prior authorization type from the dropdown
• Enter the required information and click Continue

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

PCA-1-24-01115-Clinical-NN_06172024