UnitedHealthcare CTA Chest (e.g., pulmonary embolism) prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve CTA Chest (e.g., pulmonary embolism) (CPT 71275), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for CTA Chest (e.g., pulmonary embolism) (CPT 71275).
Medical-necessity criteria UnitedHealthcare generally applies
CT angiography of the chest is appropriate (per ACR Appropriateness Criteria for Acute Chest Pain-Suspected Pulmonary Embolism) as the first-line imaging modality when pretest probability is high, or when the D-dimer is positive at low or intermediate pretest probability. Document the Wells or Geneva pretest-probability assessment and the D-dimer result.
Situations to verify before submitting
UnitedHealthcare may not cover CTA Chest (e.g., pulmonary embolism) in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Low or intermediate pretest probability with a NEGATIVE D-dimer (PE can be safely excluded without imaging per ACR criteria)","source":"ACR Appropriateness Criteria: Acute Chest Pain-Suspected Pulmonary Embolism"}
Source
Advanced imaging PA for UnitedHealthcare is managed by eviCore. Criteria summarized from ACR Appropriateness Criteria Acute Chest Pain-Suspected Pulmonary Embolism. Source: jacr.org; eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does UnitedHealthcare require prior authorization for CTA Chest (e.g., pulmonary embolism)?
Yes. UnitedHealthcare generally requires prior authorization for CTA Chest (e.g., pulmonary embolism) (CPT 71275).
What does UnitedHealthcare require to approve CTA Chest (e.g., pulmonary embolism)?
CT angiography of the chest is appropriate (per ACR Appropriateness Criteria for Acute Chest Pain-Suspected Pulmonary Embolism) as the first-line imaging modality when pretest probability is high, or when the D-dimer is positive at low or intermediate pretest probability. Document the Wells or Geneva pretest-probability assessment and the D-dimer result. 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 CTA Chest (e.g., pulmonary embolism) 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.