UnitedHealthcare Arthroplasty (Joint Replacement) prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118).
Medical-necessity criteria UnitedHealthcare generally applies
Patient requires joint replacement surgery for all states
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Arthroplasty (Joint Replacement). Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Commonly required documentation
- Clinical documentation supporting medical necessity for joint replacement
How to submit
- Method: portal
- Portal: Evicore
- Typical turnaround: about 3 days
Source
Prior authorization required for all states. Not required for emergency or urgent care. Last verified 2026-05-06.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Arthroplasty (Joint Replacement)?
Yes. UnitedHealthcare generally requires prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118).
What does UnitedHealthcare require to approve Arthroplasty (Joint Replacement)?
Patient requires joint replacement surgery for all states Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
UnitedHealthcare typically decides Arthroplasty (Joint Replacement) requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Arthroplasty (Joint Replacement) 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.