March 27, 2026
New oncology prior authorization codes required
Applies to commercial, Medicare, Medicaid and Individual Exchange plans
To comply with CMS and/or American Medical Association procedure code updates, effective Oct. 1, 2026, prior authorization will be needed for the following colony stimulating factor medication HCPCS codes when administered in outpatient settings as treatment for cancer diagnosis:
| HCPCS code | Description |
|---|---|
| G0562 | Therapeutic radiology simulation-aided field setting; complex, including acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling) |
| G0563 | Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions |
| J2860 | Injection, siltuximab, 10 mg |
These changes affect UnitedHealthcare commercial plans and UnitedHealthcare® Medicare Advantage plans in all states, as well as UnitedHealthcare Community Plan and Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans in the corresponding states:
UnitedHealthcare Community Plan
- Arizona
- Colorado
- Florida
- Hawaii
- Kansas
- Kentucky
- Louisiana
- Maryland
- Mississippi
- Nebraska
- New Jersey
- New Mexico
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Tennessee
- Texas
- Virginia
- Washington
- Wisconsin
UnitedHealthcare Individual Exchange plans
- Alabama
- Arizona
- Colorado
- Louisiana
- Maryland
- Michigan
- Missouri
- Mississippi
- North Carolina
- Nebraska
- Florida
- Georgia
- Indiana
- New Jersey
- New Mexico
- New York
- Ohio
- Oklahoma
- South Carolina
- Tennessee
- Illinois
- Iowa
- Kansas
- Texas
- Virginia
- Washington
- Wisconsin
- Wyoming
Questions? We’re here to help.
- Email unitedoncology@uhc.com
- Visit our Oncology Prior Authorization and Notification page
- Call oncology prior authorization support at 888-397-8129
PCA-1-26-00566-Clinical-NN_03242026
