Massachusetts Medicaid: Prior authorization, HCPCS coding and subscriber ID changes

To comply with state requirements, as of Jan. 1, 2026, we’ve updated the prior authorization requirements for home health services in Senior Care Options (SCO) and One Care plans that integrate both Medicare and Medicaid with HCPCS coding and member IDs. The following changes apply to UnitedHealthcare Community Plan of Massachusetts members.

Home health services prior authorization guidelines

Prior authorization is not needed for Medicaid home health services unless the member goes beyond the benefit limits set by MassHealth. Prior authorization is required if services go beyond any of the following calendar yearly limits:

Service	Annual benefit limit
Visits for intermittent skilled nursing and/or medication administration	30 visits
Home health aide	240 units
Physical or occupational therapy visits	20 visits
Speech‑language therapy visits	35 visits

Home health HCPCS coding clarification

The Centers for Medicare & Medicaid Services require the use of G codes exclusively for home health nursing therapy. Also, to comply with state requirements, we need to adhere to regulations specifying exclusive use of HCPCS G codes for skilled nursing therapy services and home health aide services supporting activities of daily living.

This means home health agencies are not required to submit HCPCS codes for the following skilled nursing therapy or home health aide services associated with activities of daily living when requesting prior authorization or submitting claims:

Service	UnitedHealthcare bill type	Revenue code	G code
Physical therapy	UB	0421	G0151
Occupational therapy	UB	0431	G0152
Speech therapy	UB	0441	G0153
Medical social services	UB	0561	G0155
Home health aide	UB	0572	G0156
Home health aide	UB	0572	G0156UD
Nursing services – Skilled nursing (registered nurse)	UB	0551	G0299
Nursing services – Skilled nursing (registered nurse)	UB	0552	G0299UD
Nursing services – Skilled nursing	UB	0551	G0493
Nursing services – Licensed practical nurse	UB	0581	G0300
Nursing services – Licensed practical nurse	UB	0582	G0300UD

Confirm member ID

Some members now have new subscriber identification numbers. Using an outdated number may result in claim rejections.

How to quickly confirm the correct subscriber identification number:

Sign in to the UnitedHealthcare Provider Portal
Navigate to Eligibility & Benefits and search by name and date of birth
Select Multiple Policies to review all active coverages and confirm the new Subscriber ID

You may also request the updated policy number directly from the member.