May 15, 2023

Texas Medicaid: Updated ICD-10 codes for dialysis

Effective June 15, 2023, we’ll require prior authorization and update the clinical criteria for sodium-glucose linked transporter 2 (SGLT2) agents. This affects UnitedHealthcare Community Plan of Texas STAR, STAR kids and STAR+Plus plans, and is based on new Texas Health and Human Services Prior Authorization Program Clinical Criteria.

Medications Clinical criteria ICD code changes
Farxiga®, Invokana®, Jardiance® and Steglatro® SGLT2 inhibitor single-entity agents

ICD-9 codes we’re removing

  • V56 - Encounter for dialysis and dialysis catheter care
  • V56.0 - Renal dialysis encounter
  • V56.1 - Ft/adj xtrcorp dial cath
  • V56.2 - Fit/adj perit dial cath
  • V56.3 - Encounter for adequacy testing for dialysis
  • V56.31 – Hemodialysis testing
  • V56.32 – Peritoneal dialysis test
  • V56.8 - Dialysis encounter, NEC

New ICD-10 code we’re adding

  • Z99.2 - Dependence on renal dialysis
Invokamet®, Segluromet®, Synjardy® and Xigduo® XR SGLT2 inhibitor combination agents

How to submit a request

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
  • In the menu, select Prior Authorizations
  • In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
  • Enter the required information and submit

If we don't receive a prior authorization request before the date of service, we'll deny the claim and you won't be able to balance bill members.



Please contact your physician advocate or call Provider Services at 888-887-9003.

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