Effective January 1, 2027, UnitedHealthcare is adding prior authorization requirements for 11 HCPCS oncology medication codes when administered in outpatient settings for cancer treatment. These codes include busulfan, leucovorin calcium, luspatercept, dexrazoxane, dinutuximab, octreotide, triptorelin, omidubicel, zoledronic acid, and cyclosporine. This change applies across commercial, Medicare Advantage, Medicaid, and Individual Exchange plans.
Action Required
Before Jan 1, 2027
By December 31, 2026: Billing team must update billing software and prior authorization workflows to require prior authorization for all 11 HCPCS oncology codes (J0594, J0643, J0644, J0896, J1190, J1246, J2354, J3315, J3406, J3489, J7516) when billed for outpatient cancer treatment. Update provider encounter templates and standing orders to flag these codes for prior auth submission before claims are processed. Train clinical and billing staff on the new requirements. Contact UnitedHealthcare oncology prior authorization support at 888-397-8129 or unitedoncology@uhc.com with questions. Failure to obtain prior authorization will result in claim denials.