UnitedHealthcare has announced that prior authorization will no longer be required for the three chiropractic manipulative treatment codes on its Medicare Advantage and Dual Special Needs (D-SNP) plans.
What Is Changing
Beginning October 1, 2026, UnitedHealthcare will no longer require prior authorization for the following CPT codes under its Medicare Advantage and Dual Special Needs Plans:
CPT Code Description 98940 Chiropractic manipulative treatment, spinal, 1-2 regions 98941 Chiropractic manipulative treatment, spinal, 3-4 regions 98942 Chiropractic manipulative treatment, spinal, 5 regions
This change is part of a broader prior authorization reduction UnitedHealthcare is applying across a long list of procedure codes on the same effective date.
What Is NOT Changing
UnitedHealthcare commercial plans are not affected. Commercial plans that currently require prior authorization for chiropractic treatment will continue to require it. The chiropractic manipulation codes do not appear anywhere on UnitedHealthcare’s commercial prior authorization reduction list.
That means practices must still determine whether Optum prior authorization is required for each commercial patient. Those requirements depend on two variables:
- The employer group associated with the patient’s plan
- The individual provider’s tier level
Do not assume that because a UnitedHealthcare Medicare Advantage patient no longer needs authorization, a UnitedHealthcare commercial patient is in the same position. They are two different rule sets.
Action Steps for Your Practice
- Verify before you treat. Continue checking requirements through the Prior Authorization and Advance Notification tool on the UnitedHealthcare Provider Portal. UnitedHealthcare notes that plan-specific exceptions can still apply.
- Update your front desk and billing workflows. If your team has a standing rule to request authorization on every UnitedHealthcare patient, that rule needs a Medicare Advantage carve-out as of October 1.
- Keep commercial verification intact. Your Optum prior authorization process for commercial plans stays exactly as it is today.
- Do not relax documentation. Removing a prior authorization requirement does not change medical necessity standards, documentation requirements, or the plan’s underlying coverage rules. Claims remain subject to review.
- Confirm patient by patient. Coverage and plan design vary. Eligibility and benefit verification at the point of service remains your best protection.
