Additional oncology medications require prior auth
Applies to commercial, Medicare, Medicaid and Individual Exchange plans
To comply with CMS and/or American Medical Association procedure code updates, effective Jan. 1, 2027, prior authorization will be needed for the following HCPCS code when administered in outpatient settings as treatment for cancer diagnosis.
Overall, we’re reducing the number of CPT® codes requiring prior authorization, but we may add prior authorization as new codes, such as these, become effective.
| HCPCS code | Description |
|---|---|
| J0594 | Injection, busulfan, 1 mg |
| J0643 | Injection, leucovorin calcium nos 1 mg |
| J0644 | Injection, leucovorin calcium avyxa 1 mg |
| J0896 | Injection, luspatercept-aamt, 0.25 mg |
| J1190 | Injection, dexrazoxane hydrochloride, per 250 mg |
| J1246 | Injection, dinutuximab, 0.1 mg |
| J2354 | Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg |
| J3315 | Injection, triptorelin pamoate, 3.75 mg |
| J3406 | Injection, omidubicel-onlv per therapeutic dose |
| J3489 | Injection, zoledronic acid, 1 mg |
| J7516 | Injection, cyclosporine, 250 mg |
This change affects UnitedHealthcare commercial plans and UnitedHealthcare® Medicare Advantage plans in all states, as well as UnitedHealthcare Community Plan and Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans in the corresponding states:
UnitedHealthcare Community Plan
- Arizona
- Colorado
- Florida
- Hawaii
- Kansas
- Kentucky
- Maryland
- Nebraska
- New Jersey
- New Mexico
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Tennessee
- Texas
- Virginia
- Washington
- Wisconsin
UnitedHealthcare Individual Exchange plans
- Alabama
- Arizona
- Colorado
- Florida
- Georgia
- Indiana
- Illinois
- Iowa
- Kansas
- Louisiana
- Massachusetts
- Maryland
- Michigan
- Missouri
- Mississippi
- North Carolina
- Nebraska
- New Jersey
- New Mexico
- New York
- Ohio
- Oklahoma
- South Carolina
- Tennessee
- Texas
- Virginia
- Washington
- Wisconsin
- Wyoming
Questions? We’re here to help.
- Email unitedoncology@uhc.com
- Visit our Oncology Prior Authorization and Notification page
- Call oncology prior authorization support at 888-397-8129
CPT® is a registered trademark of the American Medical Association.
PCA-1-26-01731-Clinical-NN_0914202
