Effective Nov. 1, 2022, we’ll require prior authorization for several outpatient injectable drugs for UnitedHealthcare Community Plan of Kentucky members.
If you administer any of these medications without first completing the Prior Authorization process, we'll deny the claim and you won't be able to bill the member for the services.
The following medications will now require prior authorization:
| HCPCS code | Description |
|---|---|
| J0172 | AduhelmTM |
| J1426 | Amondys 45TM |
| J1554 | AscenivTM |
| Q5121 | AvsolaTM |
| J0741 | CabenuvaTM |
| J7318 | Durolane® |
| J3032 | Vyepti® |
| J1305 | EvkeezaTM |
| J7326 | Gel-One® |
| J7328 | Gelsyn-3® |
| J7320 | GenVisc® 850 |
| J7321 | Hyalgan®, Supartz®, Visco-3TM |
| J7322 | Hymovis® |
| Q5103 | Inflectra® |
| 90283, 90284 | IVIG / SCIG |
| J7327 | Monovisc® |
| Q5122 | NyvepriaTM |
| Q5104 | Renflexis® |
| Q5123 | RiabniTM |
| J9311 | Rituxan Hycela® |
| Q5119 | Ruxience® |
| J7325 | Scenesse® |
| S0013 | SpravatoTM |
| J7325 | Synvisc® / Synvisc One® |
| J7331 | SynoJoyntTM |
| J3241 | Tepezza® |
| J7332 | Triluron® |
| J7329 | TriViscTM |
| J1823 | Uplizna® |
| J1427 | Viltepso® |
| J7333 | Visco-3TM |
| J1558 | Xembify® |
| Q5120 | Ziextenzo® |
How to submit prior authorization
Submit your prior authorization request on the UnitedHealthcare Provider Portal using your One Healthcare ID and the Prior Authorization and Notification tool.
Questions?
To view the clinical policies for these medications, go to Medical & Drug Policies and Coverage Determination Guidelines.
For answers to specific patient questions, call the Provider Services phone number on the member’s health care identification card.