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UnitedHealthcareMedicaid · Coverage · Medical Benefit Drug Policy · AZMedium impact

Denied Drug Codes – Pharmacy Benefit Drugs (for Arizona Only)

Act
by Oct 1, 2026
Effective date
Oct 1, 2026
Identified
Sep 2, 2026

Summary

UnitedHealthcare Community Plan of Arizona is denying payment for two specialty drugs (Lamzede [J0217] and Zevaskyn [J3389]) when billed on medical professional or outpatient facility claims. These injectable medications must now be reimbursed exclusively through the outpatient pharmacy benefit to comply with Arizona's Catastrophic Reinsurance Program requirements.

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What to do

by Oct 1, 2026 · 4 steps
01Billing team must update claim routing logic in billing system to ensure HCPCS codes J0217 (Lamzede) and J3389 (Zevaskyn) are submitted ONLY on pharmacy benefit claims for Arizona UnitedHealthcare Community Plan members.
02Remove these codes from medical professional claim forms (CMS-1500) and outpatient facility claim forms (UB-04) to prevent automatic denials.
03Communicate to providers and clinical staff that these specialty drugs cannot be billed through medical claims.
04Claims submitted on medical/facility forms for J0217 or J3389 will be denied and require rebilling through pharmacy channels.

Codes mentioned

J0217J3389

Original notice

Denied Drug Codes – Pharmacy Benefit Drugs (for Arizona Only)
uhcprovider.com · Always check the source before changing claims.
View original ↗

Related policy hubs

UnitedHealthcare policiesAZ policy changesCode J0217Code J3389

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