MedicaidPrior AuthHigh impact
Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates
UnitedHealthcare·MA · Physical Therapy, Occupational Therapy·State news
Effective date
Jan 1, 2026
We identified it
Apr 1, 2026
Summary
Massachusetts Medicaid has updated prior authorization requirements for home health services in Senior Care Options and One Care plans, clarified that Medicare certified home health services do not require prior authorization, and specified required HCPCS G codes for different home health services. Additionally, some members have new subscriber identification numbers that must be verified to prevent claim rejections.
Action Required
Immediately: Billing team must verify all Massachusetts Medicaid member subscriber IDs using the UnitedHealthcare Provider Portal before submitting claims to prevent rejections. Update billing system to reflect that Medicare certified home health services do not require prior authorization, but ASAP services using codes G0156 and G0299 still require prior authorization. Ensure home health agencies use the specified HCPCS G codes and revenue codes per the contracted payment appendix for all skilled nursing therapy and home health aide services.