Medicare AdvantagePrior AuthHigh impact
Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates
UnitedHealthcare·MA · Physical Therapy, Occupational Therapy·State news
Effective date
Jan 1, 2026
We identified it
Jun 13, 2026
Summary
UnitedHealthcare Massachusetts Medicaid updated prior authorization requirements for home health services in Senior Care Options and One Care plans, clarified that Medicare certified home health services no longer require prior authorization, and specified mandatory HCPCS G codes for billing skilled nursing and home health aide services.
Action Required
Immediately: Home health agencies must verify current member subscriber ID numbers through UnitedHealthcare Provider Portal before billing to avoid claim rejections. Update billing systems to use specified HCPCS G codes (G0151, G0152, G0153, G0155, G0156, G0299, G0493, G0300) with corresponding revenue codes per contracted payment appendix. Stop requesting prior authorization for Medicare certified home health services but continue prior auth requirements for ASAP services using codes G0156 and G0299.