UnitedHealthcare Breast Reconstruction (Non-Mastectomy) prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Breast Reconstruction (Non-Mastectomy) (CPT 15771, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19364, 19367, 19368, 19369, 19370, 19371, 19396, L8600), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Breast Reconstruction (Non-Mastectomy) (CPT 15771, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19364, 19367, 19368, 19369, 19370, 19371, 19396, L8600).
Medical-necessity criteria UnitedHealthcare generally applies
Reconstruction of the breast except when following mastectomy. Notification/prior authorization NOT required for specific breast cancer diagnosis codes (C50.xxx, C79.81, D05.xx, Z85.3, Z90.1x, Z42.1)
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Breast Reconstruction (Non-Mastectomy). Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Commonly required documentation
- Clinical documentation including indication for reconstruction
How to submit
- Method: portal
- Portal: UnitedHealthcare
- Typical turnaround: about 3 days
Source
Prior authorization required except when specific breast cancer diagnosis codes are present Last verified 2026-05-06.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Breast Reconstruction (Non-Mastectomy)?
Yes. UnitedHealthcare generally requires prior authorization for Breast Reconstruction (Non-Mastectomy) (CPT 15771, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19364, 19367, 19368, 19369, 19370, 19371, 19396, L8600).
What does UnitedHealthcare require to approve Breast Reconstruction (Non-Mastectomy)?
Reconstruction of the breast except when following mastectomy. Notification/prior authorization NOT required for specific breast cancer diagnosis codes (C50.xxx, C79.81, D05.xx, Z85.3, Z90.1x, Z42.1) Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
UnitedHealthcare typically decides Breast Reconstruction (Non-Mastectomy) requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Breast Reconstruction (Non-Mastectomy) 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.