May 15, 2023
Texas Medicaid: Updated ICD-10 codes for dialysis
Effective June 15, 2023, we’ll require prior authorization and update the clinical criteria for sodium-glucose linked transporter 2 (SGLT2) agents. This affects UnitedHealthcare Community Plan of Texas STAR, STAR kids and STAR+Plus plans, and is based on new Texas Health and Human Services Prior Authorization Program Clinical Criteria.
| Medications | Clinical criteria | ICD code changes |
|---|---|---|
| Farxiga®, Invokana®, Jardiance® and Steglatro® | SGLT2 inhibitor single-entity agents | ICD-9 codes we’re removing
New ICD-10 code we’re adding
|
| Invokamet®, Segluromet®, Synjardy® and Xigduo® XR | SGLT2 inhibitor combination agents |
How to submit a request
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and select Sign In at the top-right corner
- Sign in to the portal using your One Healthcare ID and password
- If you’re a new user and don’t have a One Healthcare ID, visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
- Enter the required information and submit
If we don't receive a prior authorization request before the date of service, we'll deny the claim and you won't be able to balance bill members.
Resources
- Training: View our Prior Authorization and Notification: Interactive User Guide
Questions?
Please contact your physician advocate or call Provider Services at 888-887-9003.
