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

Last modified: Sept. 3, 2024
Update: Added clarity about no longer requiring a site of service review for code 64590. Please review the medical policy for prior authorization requirements.

Affects UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans

Beginning Oct. 1, 2024, 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). For phase 2 (CPT code 64590), we will no longer require a medical necessity review for urinary indications.

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

What this means to you

Please review the Sacral Nerve Stimulation for Urinary and Fecal Indications medical policy for prior authorization requirements. We will not require authorization for certain diagnosis codes (urinary indications) that are listed in the medical policy. If the diagnosis code is not listed, a prior authorization is required.

How to submit a prior authorization

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-1-24-02685-UHN-NN_08292024