UnitedHealthcare (UHC) recently highlighted two initiatives designed to reduce the burden of prior authorization: the elimination of prior authorization requirements for approximately 1,700 procedure and treatment codes and its Gold Card program, which allows qualifying practices to bypass clinical prior authorization for certain services. Reducing unnecessary prior authorization is certainly welcome. Unfortunately, after further review by the Advocacy Council, we found that these initiatives offer little meaningful relief for allergy practices.
1,700 fewer prior authorizations — but little relief for allergists
UHC announced that it is eliminating prior authorization requirements for approximately 1,700 codes beginning Oct. 1, 2026, as part of its goal of reducing prior authorization requirements by about 30%. That sounds substantial. However, a careful review of the codes finds little that will reduce the everyday administrative burden faced by allergists.
Among commonly used allergy/immunology services, we found no significant reductions affecting core allergy testing, allergen immunotherapy, pulmonary testing, food or drug challenges, or administration of the major asthma biologics. Key immunotherapy codes such as 95115, 95117 and 95165 are not among those identified for prior authorization relief, nor are commonly used allergy testing and/or challenge codes such as 95004, 95044 and 95076.
Similarly, our review did not identify removal of prior authorization requirements for the major physician-administered asthma biologics, including Xolair, Nucala, Fasenra and Tezspire.
The reductions appear instead to be concentrated in other areas of medicine, including selected diagnostic services, procedures, therapy services, durable medical equipment and other categories.
The number of codes removed from prior authorization makes for an impressive headline, but it does not necessarily tell us how much administrative burden has actually been eliminated for any particular specialty. For allergists, the more important question is whether prior authorization is being reduced for the services and medications that generate substantial administrative work in everyday allergy practice.
Based on our review, the answer appears to be: It’s not being reduced by much.
There is another important caveat. Eliminating prior authorization does not necessarily eliminate the administrative burden associated with these services. As Halkovich Law recently cautioned, “no prior authorization required” does not guarantee payment or prevent a payer from later questioning coverage, medical necessity or coding. Practices should therefore continue to maintain documentation supporting the services they provide and preserve evidence that prior authorization was not required at the time of service. The same clinical information that previously may have been requested before treatment could instead become important after payment if a claim is reviewed or audited, potentially resulting in a denial or recoupment. Unfortunately, post-payment reviews and recoupments are already all too familiar to allergists.
UHC’s Gold Card program leaves allergy out
UHC’s Gold Card program takes a different approach. Rather than eliminating prior authorization altogether, it allows qualifying practices to avoid clinical review for certain services based on their history of prior authorization approvals. Advance notification is still required, but UHC does not request the usual clinical information. Once again, however, allergy practices appear to receive little practical benefit.
Our review identified essentially three Gold Card services commonly ordered by allergists that are meaningful to our specialty:
70486 – CT of the sinus/maxillofacial area without contrast
71250 – CT of the chest without contrast
71260 – CT of the chest with contrast
These studies certainly have a role in allergy practice. Sinus CTs are commonly used in evaluating chronic rhinosinusitis, while chest CTs may be needed for patients with bronchiectasis, allergic bronchopulmonary aspergillosis, immune deficiency or complicated asthma.
The problem is that relatively few allergy practices are likely to order enough of these studies to qualify for Gold Card status.
UHC generally requires a practice, measured at the tax identification number level, to have submitted at least 10 prior authorization requests for Gold Card-eligible services in each of two consecutive years, in addition to meeting UHC’s required approval rate.
For many allergists, that creates something of a Catch-22. The services for which we routinely struggle with prior authorization, particularly specialty medications and biologics, do not provide meaningful Gold Card opportunities. Meanwhile, the handful of Gold Card-eligible services relevant to allergy may not be ordered frequently enough for many allergy practices to qualify.
We support efforts by insurers to reduce unnecessary prior authorization. Eliminating prior authorization requirements and establishing Gold Card programs are both potentially useful approaches.
But these programs only reduce administrative burden for allergists when they include the services allergists perform and the medications allergists actually use. So far, despite the impressive numbers and headlines, UHC’s latest prior authorization initiatives appear to offer very little relief for allergy practices.
The Advocacy Council: ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
