UnitedHealthcare Prior Auth for Therapy: October 2026

UnitedHealthcare told the industry in May that it would cut prior authorization requirements by 30 percent for “certain outpatient therapies and chiropractic care.” The actual code lists, published September 1, 2026, are much narrower for rehab practices than the headlines suggested. Effective October 1, 2026, Medicare Advantage members get relief on exactly three speech-language pathology codes (92507, 92508, 92526) and three Medicare-covered chiropractic manipulation codes (98940, 98941, 98942). No physical therapy or occupational therapy code is on any removal list, and the commercial, Individual Exchange, and Community Plan (Medicaid) lists remove zero PT, OT, SLP, or chiropractic codes.

If your practice bills UnitedHealthcare Medicare Advantage for physical or occupational therapy, October 1 changes nothing: the outpatient therapy and chiropractic prior authorization program that launched September 1, 2024 still applies to 97110, 97140, 97530, and the rest of the 97xxx list, along with G0283. If your practice bills UHC commercial plans for PT or OT, October 1 also changes nothing, because that work has never run through CPT-level prior authorization in the first place; it runs through an Optum Physical Health clinical submission process instead.

This guide reconciles the May announcement, the September 1 code lists, and the Medicare Advantage program’s own rules so a front desk lead, biller, or owner can tell, plan by plan, whether a given UHC patient still needs an authorization, and how the surviving Medicare Advantage program works when they do. Current as of September 2026.

What did UnitedHealthcare actually announce?

On May 5, 2026, UnitedHealth Group announced that “[b]y the end of 2026, UnitedHealthcare will eliminate an additional 30% of remaining prior authorizations, including select outpatient surgeries, some diagnostic tests like echocardiograms, and certain outpatient therapies and chiropractic care,” according to the UnitedHealth Group newsroom, which also promised that “a full list will be available on UHCProvider.com before these changes take effect.” The same release framed the cuts against UHC’s own utilization numbers: “prior authorization is required for only 2% of UnitedHealthcare medical services,” and of the requests submitted, “around 92% are approved and in less than 24 hours, on average.”

UHC kept the promise on schedule. On September 1, 2026, UHCprovider.com’s Network News confirmed that “beginning Oct. 1, 2026, we’re eliminating 30% of prior authorization requirements” across five plan types: commercial, Medicare Advantage, Community, Individual Exchange, and Oxford plans. The notice links five PDFs, one per plan type, and directs providers to the Prior Authorization and Notification Tool in the Provider Portal for plan-specific exceptions.

Which therapy and chiropractic codes come off prior authorization on October 1, 2026?

We downloaded and searched all five PDFs for every PT, OT, SLP treatment, and chiropractic manipulation code. Here is what changes for rehab, by plan type, as published September 1, 2026:

The rounded totals above come from Healthcare Dive’s September 2, 2026 coverage, which reports “more than 800 codes for UnitedHealthcare’s commercial plans, about 940 for its ACA plans and approximately 120 for MA and dual special needs plans,” adding up to “roughly 1,700 medical codes.” By our own count the Medicare Advantage table lists 70 rows and the D-SNP table lists 66; UHC does not publish its own row counts, so treat any other specific number as our count, not an official one. The Medicare Advantage table also removes E0740 (a non-implanted pelvic floor electrical stimulator), E0761 (a non-thermal pulsed radiowave device), and a run of elbow, wrist, and ankle arthroscopy and arthroplasty codes (29834-29897, 24360-25446); none are rehab therapy codes, but multi-specialty and ortho-adjacent practices watching the same list should note them.

Every PDF carries the same caveat: “For plan-specific exceptions, continue to verify requirements through the Prior Authorization and Advance Notification tool” in the Provider Portal. Treat the table as a starting point, not a final answer for a specific member’s plan, since UHC’s published lists can be revised after September 1, 2026.

Does UnitedHealthcare still require prior authorization for physical therapy?

Short answer: it depends entirely on plan type, and October 1 does not change any plan’s PT or OT requirement.

Medicare Advantage: yes. The outpatient therapy and chiropractic prior authorization program that began September 1, 2024 continues unchanged for the 97xxx codes and G0283. See the next section for how it works.

Commercial: UHC’s own Commercial Advance Notification and Prior Authorization Requirements, effective July 1, 2026, does not list PT/OT under CPT-level prior authorization at all. The row for “Physical therapy/occupational therapy (PT/OT) clinical submissions” instead directs providers to the UHC Quick Group Check at myoptumhealthphysicalhealth.com, or to call OptumHealth Physical Health at 888-329-5182, to find out whether a specific group requires a clinical submission. Because this is a clinical-submission program rather than a CPT-level prior authorization, it never appeared on the October 1 removal lists.

The mechanics come from Optum’s own Clinical Submission Process Guide for UnitedHealthcare Policies, a document last revised in October 2010 that is still the version posted as of September 2026: a Patient Summary Form is required when “a new patient presents for evaluation and treatment,” when a submission “has not been previously sent,” or when treatment needs “go beyond those levels indicated in your most recent clinical submission response,” and must go in “within 10 days” of the intended start date. Functional outcome measures such as the Neck Index, Back Index, DASH, and LEFS “are highly recommended, but not required.”

Individual Exchange, Community Plan, Oxford: none of these lists include PT, OT, SLP treatment, or chiropractic manipulation codes, before or after October 1.

How the Medicare Advantage outpatient therapy prior authorization program works

UnitedHealthcare Medicare Advantage has required prior authorization for physical, occupational, and speech therapy and for chiropractic services since September 1, 2024, per UHCprovider.com. Optum Physical Health reviews these requests for medical necessity using CMS Chapter 15 criteria, applicable local coverage determinations, and InterQual criteria. Additional plans in Arizona and California joined the program effective February 1, 2026, per a separate UHCprovider.com notice.

Who is covered. The program applies to Medicare Individual plans (including Chronic SNPs) and Medicare Group Retiree plans, per the program FAQ, updated November 1, 2025. Excluded: out-of-network providers, Dual Complete plans (including Optum at Home), Nursing Home and Assisted Living Plans, Erickson Advantage, Peoples Health Plans, Preferred Care Network and Preferred Care Partners of Florida, and Rocky Mountain Medicare Advantage Plans. OptumCare and WellMed contracted providers should use the number on the member’s ID card instead.

Place of service. Prior authorization is required in office (11), off-campus outpatient hospital (19), on-campus outpatient hospital (22), ambulatory surgical center (24), independent clinic (49), and comprehensive outpatient rehabilitation facility (62) settings. Inpatient therapy and home-based services are excluded, per the 2024 launch notice, as is a Part B nursing home claim billed under bill type 22X or 24X, per the FAQ.

The six-visit, 8-week rule. Since January 13, 2025, per UHCprovider.com’s update, providers still submit a request for the entire plan of care, including full duration and visit count, but “up to the first 6 visits of a member’s initial plan of care will be covered without conducting a clinical review when the first 6 visits take place within 8 weeks of the first date of service.” Only plans asking for more than 6 visits, or running longer than 8 weeks, get a medical necessity review; the initial evaluation itself never requires prior authorization. The 6-visit allowance applies when the member is new to the practice, presents with a new condition, or has had a gap in care of 90 or more days.

Providers may begin treatment the same day as the evaluation: the FAQ confirms “up to 6 visits will be covered regardless of the status of the authorization request.” The request itself is due within 10 business days (14 calendar days) of the first date of service. Even a plan of care under 6 visits still requires timely submission; the FAQ is direct: “Yes, providers will still need to submit timely for authorization for all therapy or chiropractic visits that they intend to provide.”

The FAQ’s own worked examples show how the rule plays out:

Reviews are conducted by licensed chiropractors, physical therapists, occupational therapists, and speech-language pathologists, against LCDs, CMS Chapter 15 criteria, and InterQual criteria. A late request “may deny the claim and providers will not be able to balance bill members,” per the FAQ, and billing an in-scope code without authorization means “claims for that service will be denied and the member cannot be billed for the service.” UHC recommends submitting claims only after the authorization response arrives, through “Submission & Status” under PT, OT, ST Outpatient Therapy Transactions in the Provider Portal. Providers contracted directly with UnitedHealthcare can call 888-676-7768; those contracted with Optum can call 800-873-4575.

Two things worth flagging rather than resolving. First, the FAQ’s own impacted-code list still names 92507, 92508, 92526, and 98940-98942, the same codes coming off the Medicare Advantage removal list on October 1; the FAQ is dated November 1, 2025 and predates the September 1, 2026 removal lists, and as of September 15, 2026 UHC has not republished it. Verify current status for these six codes in the Portal tool rather than relying on the FAQ’s code list alone. Second, UHC’s pages describe the retroactive coverage window two different ways: the 2024 launch notice says authorizations “will cover dates retroactive to the date of the evaluation,” while the 2025 Arizona and California notice says they “will be retroactive to the date of the request.” We found nothing reconciling the two; the 6-visits-regardless-of-status rule and the 10-business-day window matter more day to day than which phrasing governs, but verify in the Portal if a claim’s start date is in dispute.

What changes for chiropractors on October 1?

Three CPT codes for Medicare-covered chiropractic manipulative treatment (CMT) come off the Medicare Advantage prior authorization list on October 1, 2026: 98940 (spinal, 1-2 regions), 98941 (spinal, 3-4 regions), and 98942 (spinal, 5 regions), per the Medicare Advantage and D-SNP removal PDF. These three codes do not appear on the D-SNP removal list, only on the MA list.

This removal applies only to Medicare-covered chiropractic services, which the program FAQ defines as “manual manipulation of the spine to correct subluxation,” identified by the AT modifier. Routine chiropractic, the supplemental benefit offered on some UHC Medicare Advantage plans, was never in the prior authorization program: the FAQ states “routine chiropractic services will not require prior authorization,” whether before or after October 1.

Nothing changes for commercial, Individual Exchange, Community Plan, or Oxford chiropractic billing: our search of those code lists found no chiropractic manipulation codes on any of them. For the mechanics of billing Medicare-covered CMT, including how the AT modifier works and how maintenance therapy denials come up, see our Medicare chiropractic billing guide.

What changes for speech-language pathologists?

Three SLP treatment codes come off the Medicare Advantage prior authorization list on October 1, 2026: 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder, individual), 92508 (the group version), and 92526 (treatment of swallowing dysfunction and/or oral function for feeding), per the MA and D-SNP removal PDF.

D-SNP members get a narrower version of the same relief: only 92507 and 92508 appear on the D-SNP table, and 92526 does not. Dual Complete plans (a D-SNP product) were already excluded from the Medicare Advantage outpatient therapy program, so the D-SNP table reflects whatever plan-level requirements existed for those members rather than a change to that program. No other SLP code changes; speech evaluation codes are not on the removal list, consistent with the program’s existing rule that initial evaluations do not require prior authorization.

Gold Card renewal on the same day

October 1, 2026 is also a renewal date for UnitedHealthcare’s Gold Card program, separate from the removal lists above but landing on the same date. UHC “introduced the first national Gold Card Program in October 2024,” and in its third year, “starting on Sept. 1, 2026,” began sharing how provider groups can check whether they qualified; “qualified provider groups will be eligible on Oct. 1, 2026,” per UHCprovider.com’s July 16, 2026 notice. The Gold Card program protocol (revised July 31, 2025) sets the criteria: in-network participation for at least one line of business among commercial, Medicare Advantage, Individual Exchange, and Community plans; “a minimum annual volume of at least 10 eligible prior authorizations across participating lines of business each year for 2 consecutive years across all Gold Card eligible codes”; and “a prior authorization approval rate of 92.0% or higher each year for 2 consecutive years,” measured after all appeals. Determinations “will be effective on the first day of October every year.” Qualifying practices “submit an advance notification which eliminates the need for clinical documentation review for specific Gold Card services,” per the National Gold Card program page, and status is checked in the Provider Portal’s Gold Card status lookup tool.

Here is what UHC’s public materials do not say: whether the outpatient therapy and chiropractic codes discussed above are on the Gold Card eligible code list. We found nothing confirming or denying it either way. Do not assume Gold Card status lets a qualifying group skip the Medicare Advantage outpatient therapy program’s authorization requirement; check the eligible code list in the Provider Portal directly.

A pre-visit checklist for UHC patients

Before a UHC patient’s first visit, work through this list:

For the documentation that has to support whatever plan of care you submit, see our plan of care certification guide, our PT documentation requirements guide, and common reasons PT claims get denied.

The Medicare Advantage outpatient therapy program requires providers to submit the plan of care, its duration and visit count, after the evaluation, and within 10 business days. The plan of care that ends up in the submission has to be the one that lives in the chart. PrismEHR is a multi-specialty EHR built for PT, chiropractic, orthopedic, wellness, and primary care practices. See how it fits physical therapy practices, and see our plan of care certification guide for what belongs in that documentation.