UnitedHealthcare Bariatric Surgery with Obesity Diagnosis prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Bariatric Surgery with Obesity Diagnosis (CPT 43860, 43865), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Bariatric Surgery with Obesity Diagnosis (CPT 43860, 43865).
Medical-necessity criteria UnitedHealthcare generally applies
Patient has diagnosis codes E66.01, E66.09, E66.1-E66.3, E66.8, E66.9, Z68.1, Z68.20-Z68.22, Z68.30-Z68.39, Z68.41-Z68.45
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Bariatric Surgery with Obesity Diagnosis. Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Commonly required documentation
- Clinical documentation with specific obesity diagnosis codes, BMI documentation, comorbidities
How to submit
- Method: portal
- Portal: UnitedHealthcare
- Typical turnaround: about 3 days
Source
Notification/prior authorization required for specific diagnosis codes. Center of Excellence requirement for coverage. Last verified 2026-05-06.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Bariatric Surgery with Obesity Diagnosis?
Yes. UnitedHealthcare generally requires prior authorization for Bariatric Surgery with Obesity Diagnosis (CPT 43860, 43865).
What does UnitedHealthcare require to approve Bariatric Surgery with Obesity Diagnosis?
Patient has diagnosis codes E66.01, E66.09, E66.1-E66.3, E66.8, E66.9, Z68.1, Z68.20-Z68.22, Z68.30-Z68.39, Z68.41-Z68.45 Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
UnitedHealthcare typically decides Bariatric Surgery with Obesity Diagnosis requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Bariatric Surgery with Obesity Diagnosis 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.