Even with today’s announcement, more work is needed to address the burden of prior authorization on GI patients and practices
ACG welcomes UnitedHealthcare’s announcement that it will further reduce prior authorization requirements by 30% across their commercial, Medicare Advantage, and Affordable Care Act (ACA) marketplace insurance plans. The changes take effect on October 1st.
The specific codes and procedures no longer requiring prior authorization differ depending on the insurance plan. ACG has analyzed the primary impacts for GI, including:
- For commercial and ACA plans, several of the changes affect GI procedures like colonoscopy, EGD, esophagoscopy, and liver biopsy.
- For commercial plans, UHC will no longer require ‘advanced notification’ for diagnostic and surveillance colonoscopies, EGD, and capsule endoscopy. UHC introduced this requirement in 2023, after its initial plan to require prior authorization for these procedures was met with uproar from ACG and the GI community; although it took three years, we are pleased that UHC has eliminated this program entirely.
- For commercial plans, UHC will also no longer require site-of-service necessity reviews for certain endoscopy services and screening colonoscopies performed in an outpatient hospital.
GI & Imaging Codes No Longer Requiring Prior Authorization
ACG has analyzed the changes from UHC — see which codes are impacted, effective Oct. 1, 2026.
Download the Resource“We are encouraged by this announcement from UHC, but voluntary commitments from any insurer should not be mistaken for solving the prior authorization problem,” said Stephen T. Amann, MD, FACG, Chair of ACG’s Legislative & Public Policy Council. “Lasting change requires policymakers to enact policies that protect our patients and ease the delivery of high-quality GI care—and physician advocacy is essential to making that happen.”
In 2025, the nation’s largest payers announced a set of voluntary commitments to cut prior authorization requirements. However, more work is needed to reduce the administrative burden on GI practices, which is why ACG continues to push for legislative reforms at both the federal and state levels:
- The Safe Step Act (H.R. 5509 / S. 2903), a bipartisan bill that would create a clear exception process and improve response times for step therapy protocols for the 150+ million Americans on employer-sponsored health plans.
- The Improving Seniors’ Timely Access to Care Act (H.R. 3514 /S. 1816), which would establish an electronic prior authorization process and improve transparency for Medicare Advantage plans.
- Dozens of new state laws in recent years that have improved response times, established standardized electronic forms, and increased transparency around denials and clinical criteria.
ACG will continue to fight against policies that create unnecessary barriers to high-quality GI care and advocate for reforms to ensure our patients receive the care they deserve.