UNITED HEALTHCARE


Cardiovascular Prior Auth Dx Code List

CPT Codes 75710 and 75716 require prior authorization for the below Dx codes

Code Not filtered
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E08.51
E09.51
E10.51
E11.51
E13.51
I70.201
I70.209
I70.218
I70.223
I70.232
I70.238
I70.243
I70.249
I70.263
I70.292
I70.301
I70.309
I70.318
I70.323
I70.333
I70.339
I70.344
I70.35
I70.369
I70.399
I70.408
I70.413
I70.423
I70.432
I70.438
I70.443
I70.449
I70.468
I70.493
I70.502
I70.511
I70.519
I70.528
I70.533
I70.539
I70.544
I70.561
I70.569
I70.598
I70.603
I70.612
I70.621
I70.629
I70.634
I70.641
I70.645
I70.662
I70.691
I70.699
I70.708
I70.713
I70.722
I70.731
I70.735
I70.742
I70.748
I70.763
I70.792
I70.8
I72.3
I73.89
I74.5
I75.022
I77.1
I77.77
L03.116
L97.429
L97.519
L97.819
L97.919
M79.604
M79.651
M79.662
M79.673
M86.661
M86.672
Q27.32
Q87.2
S81.801A
S91.302A
T82.319A
T82.399A
T82.868A
E08.52
E09.52
E10.52
E11.52
E13.52
I70.202
I70.211
I70.219
I70.228
I70.233
I70.239
I70.244
I70.25
I70.268
I70.293
I70.302
I70.311
I70.319
I70.329
I70.334
I70.341
I70.345
I70.361
I70.391
I70.401
I70.409
I70.418
I70.428
I70.433
I70.439
I70.444
I70.461
I70.469
I70.498
I70.503
I70.512
I70.521
I70.529
I70.534
I70.541
I70.545
I70.562
I70.591
I70.599
I70.608
I70.613
I70.622
I70.631
I70.635
I70.642
I70.648
I70.663
I70.692
I70.701
I70.709
I70.718
I70.723
I70.732
I70.738
I70.743
I70.749
I70.768
I70.793
I70.90
I72.4
I73.9
I74.8
I75.023
I77.2
I77.79
L97.319
L97.511
L97.521
L97.828
L97.929
M79.605
M79.652
M79.669
M79.674
M86.662
M86.679
Q27.39
R93.6
S81.802A
S91.309A
T82.338A
T82.818A
T82.898A
E08.59
E09.59
E10.59
E11.59
E13.59
I70.203
I70.212
I70.221
I70.229
I70.234
I70.241
I70.245
I70.261
I70.269
I70.298
I70.303
I70.312
I70.321
I70.331
I70.335
I70.342
I70.348
I70.362
I70.392

Last updated: Mar 7, 2022