August 01, 2022

Kentucky Medicaid: New prior authorization requirements for outpatient injectable drugs

Effective Nov. 1, 2022, we’ll require prior authorization for several outpatient injectable drugs for UnitedHealthcare Community Plan of Kentucky members. 

If you administer any of these medications without first completing the Prior Authorization process, we'll deny the claim and you won't be able to bill the member for the services.

The following medications will now require prior authorization:

HCPCS code Description
J0172 AduhelmTM
J1426 Amondys 45TM
J1554 AscenivTM
Q5121 AvsolaTM
J0741 CabenuvaTM
J7318 Durolane®
J3032 Vyepti®
J1305 EvkeezaTM
J7326 Gel-One®
J7328 Gelsyn-3®
J7320 GenVisc® 850
J7321 Hyalgan®, Supartz®, Visco-3TM
J7322 Hymovis®
Q5103 Inflectra®
90283, 90284 IVIG / SCIG
J7327 Monovisc®
Q5122 NyvepriaTM
Q5104 Renflexis®
Q5123 RiabniTM
J9311 Rituxan Hycela®
Q5119 Ruxience®
J7325 Scenesse®
S0013 SpravatoTM
J7325 Synvisc® / Synvisc One®
J7331 SynoJoyntTM
J3241 Tepezza®
J7332 Triluron®
J7329 TriViscTM
J1823  Uplizna®
J1427 Viltepso®
J7333 Visco-3TM
J1558 Xembify®
Q5120 Ziextenzo®

How to submit prior authorization
Submit your prior authorization request on the UnitedHealthcare Provider Portal using your One Healthcare ID and the Prior Authorization and Notification tool.

Questions?
To view the clinical policies for these medications, go to Medical & Drug Policies and Coverage Determination Guidelines.

For answers to specific patient questions, call the Provider Services phone number on the member’s health care identification card.

PCA-1-22-02476-C&S-News_07272022