Medicaid: New VBT and extremity prosthetic prior authorization codes

Beginning Sept. 1, 2026, we’ll require prior authorization for select vertebral body tethering (VBT) and upper and lower extremity prosthetics codes for the following UnitedHealthcare Community Plans:

These codes are either new codes from the American Medical Association (AMA) or codes that were previously designated as unproven. The codes fall under service categories currently requiring prior authorization, and adding the codes to prior authorization is standard practice.

VBT codes

• 0656T
• 0657T
• 0790T
• 22836
• 22837
• 22838

Upper extremity prosthetics codes

• L6034
• L6035
• L6036
• L6038
• L6039

Lower extremity prosthetics code

• L5657

Please note that benefit coverage may vary by plan as determined by state Medicaid authorities. When a code is not covered, it will not be included in prior authorization requirements. As a result, some plans may include only a subset of the codes listed below for prior authorization, rather than the full list.

Reason for the change

The VBT codes were previously classified as unproven. Based on recent updates to clinical evidence, these services are now considered proven in certain clinical circumstances. As a result, we’ll require prior authorization to enable a medical necessity review and ensure services are provided in accordance with clinical criteria. View the Vertebral Body Tethering for Scoliosis – Community Plan Medical Policy  for more information.

The upper and lower extremity prosthetics codes are newly established AMA codes that have been added to the Upper Extremity Prosthetic Devices – Community Plan Medical Policy or Lower Extremity Prosthetics – Community Plan Medical Policy. Prior authorization is required to support appropriate review and consistent application of coverage criteria.

How to submit and manage a prior authorization

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications

For training, view our Prior Authorization and Notification interactive guide.