Summary
UnitedHealthcare Community Plan of Kentucky revised its Maximum Dosage and Frequency medical benefit drug policy, updating the list of maximum allowed quantities and frequencies by HCPCS units and adding Exdensur (depemokimab) and Spinraza (nusinersen). Billing teams should check claims for these drugs against the listed per-administration maximums and dosing frequencies, and confirm that HCPCS codes J2326 and J2361 are added to charge entry and that the revised descriptions for Q5136 and Q5157 are reflected in the charge master.
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What to do
Action · 2 steps
01By 2026-12-01: Billing team should update charge entry and the drug-unit reference tables in the practice management system for Exdensur (depemokimab) and Spinraza (nusinersen), adding HCPCS codes J2326 and J2361, and revise the descriptions for Q5136 and Q5157 so claims for Kentucky Medicaid members reflect the policy's maximum allowed units and frequencies.
02Providers and front desk staff should be told which doses and dosing intervals now fall within the policy limits so orders and schedules stay within them; claims exceeding the listed maximums may be denied under the policy.
Codes mentioned
J2326J2361Q5136Q5157
Original notice
Maximum Dosage and Frequency
uhcprovider.com · Always check the source before changing claims.
Related changes
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