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Cardiology prior authorization

These programs support the consistent use of evidence-based, professional guidelines for cardiology procedures. They were designed with the help of physician advisory groups to encourage appropriate and rational use of cardiology services. Using them helps reduce risks to patients and improves the quality, safety and appropriate use of cardiac procedures.

Prior authorization

To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal.

Sign in Prior authorization

Basic requirements and process

Prior authorization may be required for the following procedures in the service locations indicated.

Electrophysiology implants, diagnostic catheterization, echocardiogram*, stress echocardiogram: Required for outpatient and office visits. Not required for inpatient, emergency room, urgent care center or observation.

*Note: For Medicare Advantage benefit plans, prior authorization is not required for echocardiograms. 

 

These requirements apply to all providers subject to the UnitedHealthcare Administrative Guide. To review the complete protocol, please refer to the Cardiology Prior Authorization Protocol section in that guide.

 

 

Special notes for congenital heart disease

  • For congenital heart disease codes, notification is required for inpatient services only
  • For outpatient help, please refer members to Optum at 888-936-7246
  • For inpatient cases, please call the phone number on the back of the member's health care ID card

 

 

Specific cardiology programs by plan

Open the section below to view more information.

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This program is effective in Arizona, Florida, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington and Wisconsin.

 

Cardiovascular and Radiology Imaging Guidelines
2025

2024

Cardiology prior authorization resources
Cardiovascular and Radiology Imaging Guidelines
2025
 
2024

Cardiology prior authorization resources

The following commercial resource materials are inclusive of UnitedHealthcare River Valley and NHP membership.

When you notify us of a planned service that is subject to the protocol, we’ll conduct a clinical review to decide if the service is medically necessary and covered, and let you know our decision.



 

If the member's benefit plan does not require a clinical review and the service does not meet clinical guidelines, or if additional information is needed, we’ll let you know whether a physician-to-physician discussion is required.

 

Cardiovascular and Radiology Imaging Guidelines
2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025

 

2024

 

Cardiology prior authorization resources
Cardiovascular and Radiology Imaging Guidelines
2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025

 

2024

 

Cardiology prior authorization resources

 

Additional resource materials are included in the commercial section above.

For information about UnitedHealthcare Oxford policies, please refer to the UnitedHealthcare Oxford Clinical, Administrative and Reimbursement Policies page. This page has all UnitedHealthcare Oxford clinical, administrative and reimbursement policies, including the following commonly referenced clinical guidelines imaging policies:

 

Cardiovascular and Radiology Imaging Guidelines
2025

 

2024

 

2023

 

Cardiology prior authorization resources