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).

General reference compiled from public sources, last verified 2026-05-06. This is not a coverage determination or medical advice. Always confirm current requirements with UnitedHealthcare before submitting.

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.

C79.81Secondary malignant neoplasm of breastZ42.1Encounter for breast reconstruction following mastectomyZ85.3Personal history of malignant neoplasm of breastZ90.1Acquired absence of breast and nipple

Commonly required documentation

  • Clinical documentation including indication for reconstruction

How to submit

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.

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Other UnitedHealthcare prior authorization requirements

ACL ReconstructionAnterior Cervical Discectomy and FusionArthroplasty (Joint Replacement)Arthroscopic Hip Surgery for Impingement Syndrome Including Labral RepairArthroscopyBariatric SurgeryBariatric Surgery with Obesity DiagnosisBody LengtheningBone Growth Stimulator - Electronic Stimulation or UltrasoundBone Marrow/Stem Cell ProceduresCancer Supportive Care - Antiemetic DrugsCancer Supportive Care - Colony Stimulating Factors

Related guides

Why was my prior authorization denied? Top reasons and how to fix eachHow to write a prior authorization appeal that cites policy