UnitedHealthcare does not use one universal prior authorization form. Medical and therapy requests are submitted in the UnitedHealthcare Provider Portal, by EDI, or by phone at 877-842-3210, and the PDF form most people find is a pharmacy form for prescription drugs. Which route applies depends on the plan type (Commercial, Individual Exchange, Medicare Advantage or Community Plan) and the service.

This guide shows which UnitedHealthcare form or channel to use, the phone and fax numbers UnitedHealthcare publishes, the current prior authorization rules for physical, occupational and speech therapy, how the Gold Card program works, and what the 2026 federal rules do and do not change. Last checked against UnitedHealthcare and CMS pages in October 2026.

Common mix-up: 877-842-3210 is the UnitedHealthcare Provider Services phone number, not a fax number. UnitedHealthcare lists one prior authorization fax, 855-352-1206, and only for Massachusetts, Nevada, New Mexico and Texas commercial plans.

UnitedHealthcare prior authorization at a glance

Which UnitedHealthcare prior authorization form do you need?

Searching for the "UnitedHealthcare prior authorization form PDF" returns many files, and they are not interchangeable. Match the request type to the right channel first.

The PDF linked from earlier versions of this guide is the pharmacy form: its sections cover member, prescriber, medication and clinical information, so it does not apply to therapy or procedure requests.

UnitedHealthcare prior authorization route finder

Pick the plan type and service to see the route and numbers UnitedHealthcare publishes.

UnitedHealthcare prior authorization phone and fax numbers

Numbers differ by plan and state. If a fax number is not listed for your plan on UHCprovider.com, use the portal instead of guessing.

How to submit a UnitedHealthcare prior authorization

1. Check whether the service needs prior authorization. Open the plan requirements list for the patient's plan and look up the CPT code. Verify eligibility and plan type first. See our guide to insurance eligibility verification.
2. Check Gold Card status. If your group qualifies for the codes you bill, you submit advance notification rather than a prior authorization.
3. Sign in to the UnitedHealthcare Provider Portal. Go to Prior Authorizations & Notifications and create a new request. For a step-by-step on access, see our UnitedHealthcare Provider Portal guide.
4. Enter member and provider details. Member ID exactly as on the card, the rendering and facility NPI, and the tax ID used for Gold Card lookup.
5. Add the clinical request. Diagnosis (ICD-10), the CPT codes, visit count and duration, plus the initial evaluation and plan of care for therapy. Use CPT and ICD-10 references to confirm codes.
6. Submit and save the reference number, then check status in the portal. For therapy transactions UnitedHealthcare notes the activity center shows the past 30 days of submissions.
7. Use phone or EDI only when the portal does not fit. EDI suits batch work. Fax applies only to the limited commercial states listed above.

UnitedHealthcare prior authorization for physical therapy, OT and speech therapy

UnitedHealthcare's Medicare Advantage therapy program is the clearest published rule. According to the UnitedHealthcare expansion notice, it applies to physical therapy, occupational therapy, speech therapy and Medicare-covered chiropractic services in office, outpatient hospital, ambulatory surgical center, independent clinic and comprehensive outpatient rehabilitation facility settings. Home health and inpatient therapy are excluded.

Which Medicare Advantage members count as an initial request: a member who is new to the office, presents with a new condition, or has had a gap in care of 90 days or more. After the initial plan is used, a new authorization is needed for more visits. The notice also says claims without authorization are denied and that members cannot be balance-billed for those denied services.

Codes covered by the Medicare Advantage program: 92507, 92508, 92526, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032 to 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97164, 97168, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97750, 97755, 97760, 97761, 97799 and G0283. Chiropractic codes 98940 to 98942 with the AT modifier are also included. Review our physical therapy CPT code reference for how these map to your billing.

Plans excluded from the Medicare Advantage therapy program include out-of-network providers, Dual Complete plans, nursing home and assisted living plans, Erickson Advantage, Peoples Health, Preferred Care Network and Partners in Florida, and Rocky Mountain Medicare Advantage plans. Practices that treat many Medicare Advantage patients can strengthen requests with standardized outcome tools. See our functional outcomes library and the 6-Minute Walk Test and Berg Balance Scale calculator.

For commercial and Individual Exchange therapy, we did not find one national rule. UnitedHealthcare publishes commercial requirements per plan, so check the CPT codes you bill against the requirements list.

UnitedHealthcare Gold Card: when you submit notification instead

The Gold Card program lets qualified provider groups send an advance notification instead of a prior authorization for eligible codes. UnitedHealthcare states that no clinical information is needed for the notification, only eligibility and network status. According to UnitedHealthcare, the program launched in 2024, and the 2026 provider notice says status is viewable from September 1, 2026, with eligibility beginning October 1, 2026.

Eligibility is set by code and by provider group, so we cannot confirm which therapy codes are on a given group's Gold Card list. Check the lookup in the portal and the Gold Card page.

2026 federal prior authorization rules: who they cover

The CMS Interoperability and Prior Authorization final rule (CMS-0057-F) sets new requirements for specific payers. The CMS fact sheet lists them as Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and Qualified Health Plan issuers on the federally facilitated exchanges. Commercial and employer plans are not mentioned as covered.

Read our explainer on the CMS 72-hour prior authorization rule and see how another payer's form works in our Carelon prior authorization form guide.

Common reasons UnitedHealthcare prior authorization requests fail

• Wrong channel or form: sending a therapy or procedure request on the pharmacy form, or faxing where fax is not offered.
• Late submission: Medicare Advantage therapy requests must arrive within 10 business days of starting service, or the claim may be denied.
• Missing evaluation or plan of care: the notice asks for initial evaluation results and the full plan, including duration and visit count.
• Mismatched codes or member data: the CPT codes requested should match what you later bill. Details should match the member's card and your real-time eligibility result.
• Visits beyond the initial window: plans beyond 6 visits or 8 weeks trigger a full clinical review, so document functional progress. Learn how to reduce claim denials.

Automating UnitedHealthcare prior authorization

The slowest parts are finding out that an authorization is needed, re-entering documentation and tracking visit counts. A prior authorization workflow built into your EMR and billing software can handle each of them. Estimate your practice's time with the prior authorization calculator, or book a demo.

Frequently asked questions

Is there one UnitedHealthcare prior authorization form PDF?

No. UnitedHealthcare directs providers to its Provider Portal tools, EDI or phone for medical requests, and publishes requirement lists by plan. The PDF commonly linked online is a pharmacy Prior Authorization Request Form for drugs.

What is the UnitedHealthcare prior authorization fax number?

UnitedHealthcare lists 855-352-1206, with limited availability: Massachusetts, Nevada, New Mexico and Texas commercial plans only. The pharmacy form lists a separate fax, 866-940-7328. Everyone else should submit through the portal.

What is the UnitedHealthcare prior authorization phone number?

Provider Services is 877-842-3210. Medicare Advantage therapy requests use 888-676-7768 (UnitedHealthcare contracted) or 800-873-4575 (Optum contracted). The Rhode Island Community Plan therapy program uses 855-766-0344.

Does UnitedHealthcare require prior authorization for physical therapy?

For Medicare Advantage, yes since the November 1, 2025 expansion, with the first 6 visits in 8 weeks exempt from clinical review but still requiring a request. The evaluation claim does not need authorization. Commercial rules vary by plan, so check the requirements list.

How long does UnitedHealthcare take to decide a prior authorization?

UnitedHealthcare does not publish one timeline across all plans in the pages we reviewed. For Medicare Advantage, Medicaid and CHIP plans covered by CMS-0057-F, standard decisions are due within 7 calendar days and expedited within 72 hours from 2026.

What happens if I don't get prior authorization?

UnitedHealthcare says claims without a required authorization are denied. For the Medicare Advantage therapy program, members cannot be balance-billed for those denied services.

How do I qualify for UnitedHealthcare Gold Card?

There is no application. Your group must be in network, have at least 10 eligible prior authorizations in each of two consecutive years, and an approval rate of 92% or higher in each year. Check status in the Provider Portal.

Can I submit UnitedHealthcare prior authorization through CoverMyMeds?

CoverMyMeds appears on UnitedHealthcare Community Plan pharmacy pages for drug requests. Medical and therapy requests go through the Provider Portal tools instead.

Do evaluations need UnitedHealthcare prior authorization?

Under the Medicare Advantage therapy program, the initial evaluation claim does not require prior authorization, but a request must still be submitted for the first 6 visits.

Sources and further reading

• UnitedHealthcare Provider: prior authorization and notification
• UnitedHealthcare: advance notification and prior authorization requirements by plan
• UnitedHealthcare: Medicare Advantage outpatient therapy prior authorization expansion (PDF)
• UnitedHealthcare Community Plan of Rhode Island: outpatient therapy prior authorization FAQ (PDF)
• UnitedHealthcare: National Gold Card program
• UnitedHealthcare: Gold Card eligibility status, 2026
• UnitedHealthcare newsroom: Gold Card
• UnitedHealthcare Community Plan of Texas: pharmacy prior authorization
• UnitedHealthcare pharmacy Prior Authorization Request Form (PDF)
• CMS: Interoperability and Prior Authorization final rule (CMS-0057-F) fact sheet

This guide is informational and is not legal or payer-specific advice. Contact numbers and requirements change, so confirm them with UnitedHealthcare before submitting.