July 01, 2024

Updates to oncology and hematology prior authorization codes for many plans

Effective Oct. 1, 2024, we’ll require prior authorization for specific services administered in outpatient settings as treatment for oncologic or hematologic conditions. This applies to the Healthcare Common Procedure Coding System (HCPCS) codes in the following table.

We’re making this change to reflect the new codes introduced by the Center for Medicare & Medicaid Services in recent HCPCS code updates. Please note that J1323 is a replacement code for discontinued code C9165.

Codes this applies to

HCPCS code Description
J1246 Injection, dinutuximab, 0.1 mg
J1323 Injection, elranatamab-bcmm, 1 mg
J1434 Injection, fosaprepitant (Focinvez™), 1 mg
J2277 Injection, motixafortide, 0.25 mg
J3055 Injection, talquetamab-tgvs, 0.25 mg
J3263 Injection, toripalimab-tpzi, 1 mg

Plans this applies to

These changes affect UnitedHealthcare® Medicare Advantage and UnitedHealthcare commercial plans in all states. For UnitedHealthcare Community Plan and UnitedHealthcare Individual Exchange plans,* changes apply to the following states:

Community Plan
Arizona Kansas Minnesota New York Tennessee Wisconsin
Colorado Kentucky Mississippi Ohio Texas  
Florida Louisiana Nebraska Pennsylvania Virginia  
Hawaii Maryland New Jersey Rhode Island Washington  
Individual Exchange plans
Alabama Illinois Michigan New Mexico South Carolina Washington
Arizona Kansas Missouri North Carolina Tennessee Wisconsin
Florida Louisiana Mississippi Ohio Texas  
Georgia Maryland New Jersey Oklahoma Virginia  


For questions about oncology prior authorization:

*Also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans


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