All PlansCoverageMedium impact
Tzield® (Teplizumab-Mzwv)
UnitedHealthcare·Endocrinology, Pediatrics·Medical Benefit Drug Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare has issued a revised medical benefit drug policy for Tzield® (Teplizumab-Mzwv) effective October 1, 2026. The policy document was published in the September 2026 UMR Medical Policy Update Bulletin. However, the specific policy content details are not provided in the source material, preventing analysis of what coverage, prior authorization, or billing requirements have changed.
Action Required
By September 30, 2026: Billing team must obtain and review the full Tzield® (Teplizumab-Mzwv) policy document from the UnitedHealthcare provider portal (https://www.uhcprovider.com/content/dam/provider/docs/public/policies/mpub-archives/umr/umr-medical-policy-update-bulletin-september-2026.pdf). Identify specific coverage criteria, prior authorization requirements, and applicable billing codes. Update billing software, encounter forms, and provider guidance documentation accordingly before the October 1, 2026 effective date. Failure to implement required prior authorization or comply with coverage criteria will result in claim denials. Contact UHC provider services if the full policy document is unavailable.