July 20, 2023

New oncology prior authorization codes

Affects UnitedHealthcare commercial plans, Community Plans, Individual Exchange plans and Medicare Advantage plans

Effective Oct. 1, 2023, we’ll require prior authorization for the following colony-stimulating factor medication HCPCS code when administered in outpatient settings as treatment for cancer diagnosis:

HCPCS code Description
J1449 Injection, eflapegrastim-xnst, 0.1 mg

These changes affect UnitedHealthcare commercial plans and UnitedHealthcare® Medicare Advantage plans in all states, as well as UnitedHealthcare Community Plan and UnitedHealthcare Individual Exchange* plans in specific states, as outlined below.

UnitedHealthcare Community Plan

Arizona Kentucky Mississippi Ohio Texas
Florida Louisiana Nebraska Pennsylvania Virginia
Hawaii Maryland New Jersey Rhode Island Washington
Kansas Minnesota New York Tennessee Wisconsin

UnitedHealthcare Individual Exchange plans

Alabama Illinois Michigan Ohio Texas
Arizona Kansas Missouri Oklahoma Virginia
Florida Louisiana Mississippi Tennessee Washington
Georgia Maryland North Carolina    

How to submit prior authorization requests 

You can submit a prior authorization request through the UnitedHealthcare Provider Portal: 

  • Go to and select Sign In at the top-right corner 
  • Sign in to the portal using your One Healthcare ID and password 
  • If you are a new user and don’t have a One Healthcare ID, visit to get started 
  • In the menu, select Prior Authorizations 
  • In the Prior Authorization and Notification tool, go to “Create a new notification or prior authorization request” and click Create New Submission 
  • Enter the required information and submit 

To support our review, we’ll document clinical requirements within the request submission. You may also be asked to attach medical records. 


For questions about oncology prior authorization:

* Individual Exchange plans are also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans
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