UnitedHealthcare ACL Reconstruction prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve ACL Reconstruction (CPT 29888, 29889), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for ACL Reconstruction (CPT 29888, 29889).
Medical-necessity criteria UnitedHealthcare generally applies
Prior authorization required (Arthroscopy category, all states). UnitedHealthcare considers knee surgery proven and medically necessary in certain circumstances and delegates the ACL reconstruction medical-necessity criteria to McKesson InterQual CP: Procedures (Arthroscopy or Arthroscopically Assisted Surgery, Knee); the specific InterQual thresholds (tear confirmation, instability findings, conservative-care duration) are proprietary and not published in the UHC policy. CPT 29888 and 29889 are in the applicable-code list, and ACL reconstruction is not on UHC's unproven list.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for ACL Reconstruction. Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Related procedure codes
Codes often billed alongside ACL Reconstruction: 29888, 29889. Verify the correct codes for your documentation.
Commonly required documentation
- MRI/operative documentation of ACL tear and instability
- conservative-care history per the InterQual knee-arthroscopy subset.
How to submit
- Method: UnitedHealthcare Provider Portal (Prior Authorization and Notification; 888-936-7246)
- Portal: UnitedHealthcare Provider Portal
Source
Source: UHC Commercial Surgery of the Knee policy 2026T0553II (eff 2026-06-01) + UHC Commercial PA Requirements (eff 2026-01-01). Detailed criteria are proprietary InterQual (not published). UHC announced a ~30% PA reduction by end of 2026 - re-verify 29888 PA status at submission. Last verified 2026-06-17.
Frequently asked questions
Does UnitedHealthcare require prior authorization for ACL Reconstruction?
Yes. UnitedHealthcare generally requires prior authorization for ACL Reconstruction (CPT 29888, 29889).
What does UnitedHealthcare require to approve ACL Reconstruction?
Prior authorization required (Arthroscopy category, all states). UnitedHealthcare considers knee surgery proven and medically necessary in certain circumstances and delegates the ACL reconstruction medical-necessity criteria to McKesson InterQual CP: Procedures (Arthroscopy or Arthroscopically Assisted Surgery, Knee); the specific InterQual thresholds (tear confirmation, instability findings, cons… Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting ACL Reconstruction to UnitedHealthcare?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.