UnitedHealthcare (UHC) will stop requesting advance notification for select GI endoscopy procedures and end all GI site-of-service reviews — including for screening colonoscopy — for UHC commercial plan members and Oxford plan members in New York and Connecticut beginning Oct. 1, 2026.
The advance-notification change covers esophagogastroduodenoscopy, capsule endoscopy, and diagnostic and surveillance colonoscopy. Screening colonoscopies were not subject to advance notification, but they and a subset of the other endoscopy services required site-of-service medical-necessity review when planned in a hospital outpatient setting. For procedures performed on or after Oct. 1, those reviews will end as well. UHC said in a Sept. 1 provider notice the changes are intended to “simplify access to care and reduce complexity.” They arrived alongside a broader Sept. 1 disclosure of roughly 1,700 codes coming off prior authorization across UHC plans, fulfilling the insurer’s May commitment to cut 30% of its remaining prior authorization volume by the end of 2026.
For AGA, the changes close out the advance-notification process UHC adopted after withdrawing its contested 2023 prior authorization proposal and go further by eliminating GI site-of-service reviews that predated that fight.
An earlier round of UHC prior authorization reductions had included little for gastroenterology, said Leslie Narramore, AGA’s senior director of regulatory affairs, so AGA was initially cautious. Its review of the newly published commercial code list changed that. “They managed to grab all of the codes that represent the high-volume services that GIs do,” she said. “It’s a significant win for those who have a high market share of United.”
AGA’s review found that the commercial list captures the high-volume EGD, colonoscopy, capsule endoscopy, and screening-colonoscopy codes most relevant to GI practices. The GI-specific announcement does not encompass every endoscopic procedure; ERCP and certain small-bowel endoscopy services fall outside the categories it names, Narramore said. AGA is reviewing whether any separate plan-specific requirements apply to those services.
“Anytime an insurer says we’re going to lessen the administrative burden on our members, it’s a welcome sign,” said Kathleen Teixeira, AGA’s vice president of practice and advocacy. “We know that prior authorization is a tremendous burden on our physicians and their practices.”
What changes for GI practices
Beginning Oct. 1, UHC will no longer request advance notification for the listed procedures for affected commercial and Oxford members, and site-of-service review will end for procedures performed on or after that date.
AGA cautioned that the change does not eliminate every preprocedural step. Practices may still choose to seek predetermination for payment certainty and liability reasons, Narramore said, so some burden will remain. “But I do think it will result in a meaningful reduction, because you don’t have to go through that second step” to feel confident a procedure will be paid, she said.
Some operational details remain unresolved. UHC’s public notice confirms that site-of-service review will end for affected procedures performed on or after Oct. 1, but it does not explain how pending requests will be handled, whether portal prompts will stop automatically, or whether practices need to change any internal workflows. AGA expects additional logistical guidance in the coming weeks. UHC continues to direct practices to verify member-specific requirements through its Prior Authorization and Notification tool because plan-specific exceptions may apply.
AGA documented member reports of substantial administrative burden soon after the program began. In an August 2023 letter to UHC, AGA said large practices reported spending five to seven minutes per patient on notification entries, estimated workload increases of 25% to 35%, and in some cases dedicated full-time employees to UHC accounts.
Teixeira said the change removes one layer of a broader utilization-management burden that consumes substantial staff and physician time. “Practices, depending on the size, have full-time employees — this is all they do,” Teixeira said. “It frees up time for the office staff and for the physician, who a lot of times needs to get on the phone and do a peer-to-peer. Hopefully it will speed up the time to care for patients.”
Pairing public advocacy with payor partnership
AGA views the announcement as the most visible result of a deliberate expansion of its advocacy strategy. After the 2023 campaign, the association launched its Payor Partnership — chaired by Lawrence Kosinski, MD, MBA, a former AGA Governing Board member — to establish a regular cadence of meetings with national and regional payors around what Kosinski calls the three C’s: communicate, collaborate, and co-create solutions for patients.
Teixeira said UHC framed the decision as part of a shared commitment to simplify systems and allow physicians to spend more time with patients and told AGA it was the organization UHC wanted to inform first.
“A lot of the work we’re doing is not exciting; it’s slogging along, coordinating meetings, continuing the dialogue,” Teixeira said. “Sometimes it’s really slow, and you feel like you’re getting nowhere. And then, all of a sudden, the jam breaks.”
The relationship now runs in both directions, Narramore said. Payors increasingly seek AGA’s clinical expertise and feedback as they develop policies affecting GI care, while AGA invites them, like other stakeholders, to comment during the public-review period for new clinical guidelines. She said AGA has been “pleasantly surprised” that the willingness to engage extends across the major payors, not just UHC.
“They’re one of the biggest payors, so I think it will have an impact,” Teixeira said. “We hope this will lead to changes for the other major payors. It doesn’t mean that we support everything that they do. But we feel like we’ve really made progress. Change often comes slow, but this is really important progress.”
How the program got here
UHC announced in March 2023 that it would require prior authorization for 61 nonscreening GI endoscopy codes in many commercial plans. AGA made blocking the policy a priority. More than 175 physician groups, patient organizations, and other stakeholders joined the opposition, and the three national GI societies met with UHC days before implementation. On May 31, 2023 — one day before the start date — UHC withdrew the requirement and substituted advance notification, which it said would collect data to “accelerate gold carding” for eligible groups.
Because UHC did not deny claims over missed notifications, participation was effectively optional, and AGA continued to oppose the process as duplicative work without demonstrated benefit.
UHC later launched a broader National Gold Card program, but AGA said it has not identified GI groups that received Gold Card status through the endoscopy pathway described during the 2023 dispute.
“So far, we haven’t found any GIs who have received the elusive Gold Card through that pathway,” Narramore said.
Under UHC’s national program, qualifying groups still submit advance notification for designated Gold Card services. The Sept. 1 GI notice does not move endoscopy into that program. It ends advance notification altogether, effectively making the proposed GI-specific pathway moot.
“We can move the needle.”
Asked what she would tell a GI practice about the news, Narramore encouraged members to track whether the change improves their day-to-day operations and share what they find with AGA. Many members see payors as obstructionists, she said, and the systems they navigate are genuinely burdensome, which is why the announcement matters beyond its specifics. “We can move the needle, and this is proof,” she said.
Teixeira recalled a time when members felt differently. “Years ago, there was this sense from members that they were just defeated, like we have no leverage,” she said. That changed with the UHC fight: “We have to do what we can to push back when necessary, but it’s also important to work with them,” she said. “We bring some credibility to the table. We have the expertise on many of these issues that they don’t, quite frankly. And so, I think it’s in their interest to engage with us.”