Outpatient therapies prior authorization program for Medicare Advantage expanding to Arizona and California

Beginning Feb. 1, 2026, UnitedHealthcare will expand the current prior authorization requirement for physical, speech and occupational therapy (PT, ST and OT) and traditional Medicare chiropractic services (as identified by the AT modifier) to include UnitedHealthcare® Medicare Advantage individual and group retiree plan members in specific plans in Arizona and California.

This prior authorization program began Sept. 1, 2024, in other states. This expansion creates more consistency for your team in treating UnitedHealthcare® Medicare Advantage and UnitedHealthcare® Medicare Advantage Dual complete members.

What you need to know

With this expansion, all contracted providers will be required to submit prior authorizations. You can start submitting prior authorization for impacted plan members beginning January 1, 2026. A list of impacted plans in Arizona and California is listed in our Prior authorization changes for outpatient therapy services FAQ.

For dates of service beginning Feb. 1, 2026, prior authorizations can be submitted through the portal for any plans of care beginning Jan. 1, 2026.

Program summary

Prior authorization should be submitted after the initial evaluation. It is required for the entire plan of care, including the full duration and number of visits requested, for all outpatient therapy (PT, ST, OT) and chiropractic services. Please note the following important requirements:

The first 6 visits of a member’s initial plan of care will be covered without conducting a clinical review when the first 6 visits take place within 8 weeks of the first date of service. A prior authorization request must still be submitted for the 6 visits.
Only care plans requesting more than 6 visits or care plans exceeding 8 weeks will be assessed for medical necessity
The initial consultation/evaluation still does not require prior authorization, any additional care after the evaluation does require authorization
Authorization requests can be submitted up to 10 business days (14 calendar days) following the first date of service. Authorizations, when issued, will be retroactive to the date of the request.

Which plans are excluded from the new requirement?

Out-of-Network providers
UnitedHealthcare® Dual Complete plans
UnitedHealthcare Nursing Home and UnitedHealthcare Assisted Living Plans
Erickson Advantage
Peoples Health Plans
Preferred Care Network and Preferred Care Partners of Florida
Rocky Mountain Medicare Advantage Plans

Resources

Details on exclusions, impacted CPT® codes, clinical examples and the authorization and claims submission process are included in our program FAQ. Additional resources include: