What Is Changing With UnitedHealthcare Pediatric Prior Authorization for Radiology?
As of December 1, 2026, UnitedHealthcare is eliminating prior authorization requirements on select CPT codes for patients under the age of 18, including certain diagnostic imaging procedures. The change applies to UHC commercial and Medicaid plans and is part of a broader initiative to remove two-thirds of all pediatric prior authorization requirements by the end of 2026. Radiology practices that image pediatric patients must verify which specific codes are affected and update their authorization workflows before the effective date.
- Who is affected: Radiology practices, imaging centers, and hospital radiology departments that perform diagnostic imaging on UHC members under 18 years old.
- What is being removed: Prior authorization on select outpatient imaging codes for pediatric patients, including certain CT, MRI, and other diagnostic studies that are consistently approved.
- What still requires PA: Codes with higher clinical complexity, experimental treatments, and services required by government regulation will still require prior authorization even for patients under 18.
What UHC Announced and Why It Matters
On May 29, 2026, UnitedHealthcare announced it would remove nearly two-thirds of all prior authorization requirements for health plan members under 18 by the end of 2026. The announcement named diagnostic imaging as one of the categories where pre-approval would be eliminated for select procedures. The effective date for the radiology-relevant changes is December 1, 2026, with implementation applying to UHC commercial plans and Medicaid plans.
This follows a pattern of UHC scaling back prior authorization across its book of business. Earlier in 2026, UHC committed to cutting 30 percent of all its PA requirements and began standardizing electronic prior authorization submission across more than 70 percent of its PA volume. For radiology specifically, UHC had already removed PA on select nuclear imaging, obstetrical ultrasound, and echocardiogram procedures as of January 1, 2026.
However, UHC simultaneously expanded prior authorization requirements for other radiology services. The company added PA requirements for Surest plan radiology services effective October 1, 2026, covering outpatient CT, MRI, MRA, and PET scans for those plans. The net effect is that UHC is not uniformly removing prior authorization. It is restructuring which plans, which populations, and which codes require it, and which do not.
In our experience matching providers with billing partners, this is exactly the kind of change that creates claim errors. When a payer makes two opposite moves at the same time, one adding PA on certain plans and one removing it on a certain age group, billing teams that update for one and miss the other end up either submitting unnecessary authorizations or skipping required ones. Both cost the practice money.
Which Radiology Practices Are Affected by This Change?
The December 1, 2026 change applies to any practice that images patients under 18 on a UnitedHealthcare commercial or Medicaid plan. That includes freestanding radiology groups, pediatric imaging centers, hospital-based radiology departments, urgent care facilities with imaging, and orthopedic or multispecialty practices that order and bill for in-house imaging on pediatric patients.
The scope is not limited to pediatric-only practices. Any radiology operation that sees a mix of adult and pediatric patients needs to build a workflow that distinguishes between the two populations at the point of scheduling and authorization. A practice that images 20 percent pediatric patients cannot simply turn off PA for UHC across the board, because the adult PA requirements remain unchanged.
| Factor | Before December 1 | After December 1 |
| PA for select pediatric imaging (under 18) | Required on most outpatient imaging | Eliminated on select codes |
| PA for adult imaging | Required per plan PA schedule | Unchanged |
| Clinically complex pediatric services | Required | Still required |
| Applicable plans | UHC commercial and Medicaid | UHC commercial and Medicaid (no change to Medicare Advantage) |
Providers often come to us after discovering that a payer policy change they assumed was universal only applied to a subset of plans. The December 1 change does not apply to Medicare Advantage or D-SNP plans, which retain their existing PA structures for imaging. Verifying coverage type at intake is the first line of defense against both unnecessary PA submissions and missed authorizations.
Payer PA changes like this one create billing workflow gaps that leak revenue on both sides: wasted staff time on authorizations that are no longer needed, and denials on codes that still require them. A billing partner that tracks payer policy updates and adjusts claim workflows before the effective date protects your imaging revenue. Get matched with vetted radiology billing companies through Billing Service Quotes at no cost.
What to Do Before December 1
The December 1 effective date is less than six weeks away. These steps protect your practice from both unnecessary authorization work and missed authorizations that result in claim denials.
- Identify your UHC pediatric imaging volume. Pull a report of all imaging claims billed to UHC commercial and Medicaid plans for patients under 18 in the last 90 days. This tells you how many claims per month the change touches and which CPT codes are involved.
- Verify the specific codes affected. UHC is not eliminating PA on all pediatric imaging. The removal applies only to select codes for patients under 18. Check the UHC Provider Portal and the updated radiology prior authorization resources for the exact code list by plan type. Do not assume a code is exempt until you have confirmed it.
- Update your scheduling and intake workflow. Build an age-based check into the scheduling process that flags patients under 18 on UHC plans. Route those encounters through the updated PA logic so that your front desk is not submitting authorizations on codes that no longer require them.
- Keep your adult PA workflow intact. The PA requirements for adult UHC members are unchanged. Do not turn off PA verification for UHC across the board. The workflow must distinguish by patient age and plan type.
- Confirm Medicare Advantage is excluded. This change does not apply to UHC Medicare Advantage or D-SNP plans. Patients on those plans retain existing PA requirements regardless of age.
- Brief your billing and coding team. Make sure every person who touches radiology claim submission or prior authorization knows the December 1 date, the age threshold, and the plan-type exclusions. A five-minute briefing now prevents a month of preventable denials in December.
The most common issue we see providers run into with payer PA changes is treating the announcement as if it is already in effect. Until December 1, your existing authorization workflow for pediatric UHC patients remains active. Submitting claims in November without the required PA will still result in a denial, even if the code will be exempt 30 days later.
Common Mistakes When a Payer Drops Prior Auth
Across the billing companies we vet, we see the same handful of errors every time a major payer restructures its authorization requirements. These are preventable if the practice catches them before the effective date.
- Applying the change before the effective date. A December 1 effective date means claims with dates of service before December 1 still require the existing authorization. Practices that stop submitting PAs early based on the announcement will see denials on those November claims.
- Assuming the change applies to all UHC plans. The pediatric PA removal covers UHC commercial and Medicaid plans. Medicare Advantage and D-SNP plans are excluded. A billing team that stops checking PA for every UHC patient under 18, regardless of plan type, will miss required authorizations on MA patients.
- Dropping PA on codes that still require it. UHC stated it will continue to require pre-approval for services with higher clinical complexity or variability. Not every pediatric imaging code is included in the removal. A blanket assumption that all imaging is exempt for patients under 18 creates denial exposure on the codes that were not removed.
- Failing to update EHR or practice management system rules. If your system has hard-coded PA requirements for UHC imaging, those rules will continue to flag every pediatric imaging order for authorization even after December 1. Update the rules in your system so your staff is not doing unnecessary work.
- Not reconciling December claims. Review your first two weeks of December UHC pediatric claims to confirm the change is applying as expected. Catch any misapplied denials or missed authorizations early, while the timely filing window is wide open.
How This Fits the Broader Radiology PA Landscape
UHC’s pediatric PA reduction is part of a wider industry shift. Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), impacted payers have been required since January 1, 2026 to meet new decision turnaround requirements: 72 hours for urgent requests and 7 calendar days for standard ones. Humana eliminated PA for select outpatient CT and MRI exams as of January 1, 2026. The Improving Seniors’ Timely Access to Care Act, backed by the American College of Radiology and other societies, advanced out of committee in June 2026 and would further streamline PA in Medicare Advantage.
For radiology practices, the operational challenge is that PA requirements are not shrinking uniformly across payers. UHC is removing some and adding others simultaneously. Commercial payers are still delegating imaging PA to radiology benefit managers like eviCore, Carelon, and Evolent, each with their own clinical criteria. A practice billing across five or six major payers now has to maintain a different PA workflow for each one, and those workflows change quarterly as payers update their code lists. That is the core reason radiology billing teams fall behind on PA compliance: the volume of policy changes exceeds what a small or mid-size team can track in real time. Staying current on developments like the NCCI Q4 2026 edit updates alongside shifting payer PA policies is where a dedicated billing partner earns its value.
Frequently Asked Questions
The changes take effect December 1, 2026. Select diagnostic imaging codes for patients under 18 on UHC commercial and Medicaid plans will no longer require prior authorization after that date. Claims with dates of service before December 1 still require authorization under the existing rules.
UHC has not published a single universal code list. The specific codes affected vary by plan type and are available through the UHC Provider Portal and the updated radiology prior authorization resources. Practices should verify each code for each plan rather than assuming blanket coverage.
No. The pediatric PA elimination applies to UHC commercial and Medicaid plans only. Medicare Advantage and Dual Special Needs Plans (D-SNP) retain their existing prior authorization requirements for imaging regardless of patient age.
No. UHC stated it will continue to require pre-approval for services with higher clinical complexity or variability, experimental treatments, and services required by government regulation. Only select codes that are consistently approved are being removed from the PA requirement.
The authorization will process, but your staff will have spent time on a submission that was unnecessary. While it will not cause a denial, it adds administrative cost and delays scheduling. Update your workflow to skip PA on the exempt codes so your team is not doing redundant work.
Log in to the UHC Provider Portal and review the radiology prior authorization resources for the plans your practice accepts. Cross-reference the updated code list against your top pediatric imaging CPT codes to identify which ones are exempt as of December 1.
Next Steps
- Already tracking UHC PA changes? Read our coverage of the UHC Surest plan prior authorization requirements that took effect October 1 to make sure your team caught both changes.
- Need to brush up on modifier 26 and component billing? Get the full guide so your December claims go out with the right modifiers.
- Ready to hand off payer policy tracking to a billing team that stays current? Get matched below.
Payer authorization rules change quarterly, and every missed update costs your practice in either wasted staff time or preventable denials. A specialized radiology billing partner tracks these changes for you, updates your claim workflows before effective dates, and catches the errors your in-house team does not have bandwidth to watch for. Billing Service Quotes has connected more than 2,000 providers across all 50 states, with over 15 years in medical billing and rates starting as low as 2.95%. Finding a match is 100% free for providers.
