Massachusetts Medicaid: Prior authorization, HCPCS coding and subscriber ID changes

To comply with state and federal requirements, as of Jan. 1, 2026, we’ve updated the prior authorization requirements for home health services in Senior Care Options (SCO) and One Care plans that integrate both Medicare and Medicaid with HCPCS coding and member IDs. The following changes apply to UnitedHealthcare Community Plan of Massachusetts members.

Home health services prior authorization guidelines

Contrary to the information provided in our prior notifications on this issue, prior authorization is not required for Medicare certified home health services irrespective of any annual benefit limits.  However, all services are subject to medical necessity criteria clinical review.

Aging Services Access Points (ASAPs) will continue to require prior authorization when billing for services using HCPCS codes G0156 and G0299 along with any applicable modifiers.

Home health HCPCS coding clarification

The Centers for Medicare and Medicaid Services (CMS) require the use of G codes exclusively for home health nursing therapy. Also, to comply with state requirements, we need to adhere to regulations specifying exclusive use of HCPCS G codes for skilled nursing therapy services and home health aide services supporting activities of daily living.

This means home health agencies are not required to submit HCPCS codes for the following skilled nursing therapy or home health aide services associated with activities of daily living when requesting prior authorization or submitting claims. You should use the revenue and HCPCS code specified in your agency’s contracted payment appendix.

Confirm member ID

Some members now have new subscriber identification numbers. Using an outdated number may result in claim rejections.

How to quickly confirm the correct subscriber identification number:

• Sign in to the UnitedHealthcare Provider Portal
• Navigate to Eligibility & Benefits and search by name and date of birth
• Select Multiple Policies to review all active coverages and confirm the new Subscriber ID

You may also request the updated policy number directly from the member.