CurrentColorado Rocky Mountain Health Plans | UnitedHealthcare Community Plan (Texas STAR fragment)Policy N/A

Prior authorization requirements for Texas STAR (partial extract)

Partial extract (part 1 of 9) of prior authorization requirements for UnitedHealthcare Community Plan of Texas STAR providers, listing services, HCPCS/CPT/J-codes and effective dates and instructions for submitting prior authorization requests.

Policy Summary

PayerColorado Rocky Mountain Health Plans | UnitedHealthcare Community Plan (Texas STAR fragment)

PolicyPrior authorization requirements for Texas STAR (partial extract)

Policy CodePolicy N/A

Change TypePartial extract / informational (no material change)

Effective DateApr 1, 2026

Next Review Date

Key ActionSubmit prior authorization requests via the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or via chat; obtain One Healthcare ID at UHCprovider.com/access if needed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes identified in this fragment (has_material_change = false).

part 1 of 9Document is partial

manyCodes listed (fragmentary)

multipleHas effective dates present

Texas STARProgram scope

2026-04-01Policy effective date

Policy fragment summary & scope

This content is a partial extract (Part 1 of 9) of UnitedHealthcare Community Plan prior authorization (PA) requirements for the Texas STAR program. It lists examples of services, CPT/HCPCS/J/Q codes and some submission instructions (online Prior Authorization and Notification tool on UHCprovider.com or chat) and notes exceptions such as no PA for emergency/urgent care. The fragment includes oncology/injectable chemotherapy codes, bone growth stimulator and bariatric/breast reconstruction items, numerous DME and L-code prosthetic/orthotic codes, and many repeatedly listed J-codes (e.g., J9246, Q5119). The fragment is heavily duplicated and incomplete; refer to the full policy for complete rules and additional parts of the table.

Metadata

scope_summaryPartial extract (Part 1 of 9) of prior authorization requirements for UnitedHealthcare Community Plan Texas STAR providers listing many services, HCPCS/CPT/J-codes, effective dates and submission instructions.

payerUnitedHealthcare Community Plan (Texas STAR). Colorado Rocky Mountain Health Plans noted in metadata.

statusCURRENT

fragment notePart 1 of 9

primary submission channelSubmit PA via Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal (or chat via Contact us).

primary contactPrimary phone contacts: 866-889-8054; for certain chemotherapy codes call 866-604-3267.

Prior authorization: high-level rules

General submission and emergency rule

Submit prior authorization requests using the UnitedHealthcare Provider Portal (One Healthcare ID) or chat. Emergency/urgent care is exempt; out-of-network requests must be made by a network care provider.

Online: Use the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal at UHCprovider.com. Sign in with your One Healthcare ID and password; if you do not have one, visit UHCprovider.com/access to register.

Chat: 24/7 chat via the Contact us page on UHCprovider.com.

Emergency/Urgent care: Prior authorization is not required for emergency or urgent care.

Out-of-network requests: Must be submitted by a network care provider.

Service-specific prior authorization requirements (fragment)

This fragment lists service-specific prior authorization requirements for Texas STAR. Each top-level branch below represents a service group; operator = any indicates at least one listed branch item triggers prior authorization. Effective dates and applicable diagnosis gating are noted where available.

Code lists (selected groups from fragment)

These code tables reflect a fragmentary extract — some codes appear duplicated across groups in the source. Effective dates and diagnosis gating are available only in the full policy; consult the policy source for authoritative billing guidance.

What providers must do

Prior Authorization

Submit prior authorization requests

Submit requests via the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or via chat; if you don’t have a One Healthcare ID, visit UHCprovider.com/access to obtain access.

Portal: UHCprovider.com > Sign In > Prior Authorization and Notification tab
Access: UHCprovider.com/access (One Healthcare ID)

Documentation Required

Emergency/urgent care exception

Prior authorization is not required for emergency or urgent care. For out-of-network care, prior authorization requests must be submitted by a network care provider.

Key terms from this fragment

Definitions

Prior Authorization and Notification toolThe online portal tool on the UnitedHealthcare Provider Portal used to submit prior authorization requests.

Oncology DX codesDiagnosis codes indicating a cancer diagnosis; used as a condition for prior authorization of many chemotherapy and supportive care drugs in this fragment.

Texas STARTexas Medicaid STAR managed care program for which these prior authorization requirements apply.

(duplicate def) Texas STARTexas Medicaid managed care program (STAR) — repeated definition in fragment.

Therapy and radiology — exceptions & site-of-service notes

Specific therapy/radiology exceptions with effective dates or instructions

Each listed Subcategory/Code requires prior authorization as indicated; many entries include an effective date and additional instructions.

Outpatient Therapy / Radiology exceptions

Outpatient Therapy S9152: Outpatient Therapy code S9152 — Prior authorization required (effective Dec. 1, 2022).
Therapy re-evaluations 70371, 92626: Therapy codes 70371 and 92626 — Prior authorization for re-evaluations and other therapy (effective July 1, 2017).
Therapy notification 97760: Therapy code 97760 — Notification required (prior auth effective Nov. 7, 2016) per fragment entries.

Prior authorization required entries (code-level listing)

Each listed code/subcategory indicates a requirement for prior authorization for Texas STAR as noted (when an effective date or instruction is present).

PA required code-level listing (selected examples)

E0760: Code = E0760 (Bone growth stimulator device) — Prior authorization effective Dec. 7, 2015.
E0747: Code = E0747 (stimulator) — Prior authorization listed; neurostimulator entries include Jan. 1, 2015 effective date in fragment.
E0748: Code = E0748 (stimulator) — listed for PA.

Revision history (document-level changes)

2026-04-01Effective DateLatest

Compilation effective date (header) present in fragment; full policy revision history requires complete document.

Fragment limitations & next steps

This document is a heavily duplicated, incomplete fragment (confidence = 0.45). Consult the complete UnitedHealthcare Community Plan Texas STAR prior authorization table on UHCprovider.com (Provider Portal > Prior Authorization and Notification) for authoritative rules. Also check individual drug policies and the "Review at Launch" list for new-to-market medications referenced in the full policy. Verify effective dates and diagnosis-specific PA requirements before billing. If unclear, use the Provider Portal submission tools or contact the phone numbers shown in the policy (for example, general PA resources 866-889-8054, oncology PA contact 866-604-3267, or other vendor contacts noted in the full policy).

Policy Summary

PayerColorado Rocky Mountain Health Plans | UnitedHealthcare Community Plan (Texas STAR fragment)

PolicyPrior authorization requirements for Texas STAR (partial extract)

Policy CodePolicy N/A

Change TypePartial extract / informational (no material change)

Effective DateApr 1, 2026

Next Review Date

SourceLink

On This Page

Bariatric: Codes noted include 43644, 43645. Prior authorization effective date: Jan. 1, 2015.

Bone Growth Stimulator: Codes include 20975, 20979 (also listed with 20974 in some entries). Prior authorization effective dates include Jan. 1, 2014; Jan. 1, 2015; Oct. 1, 2022; and Apr. 1, 2026 depending on code/plan.

Breast Reconstruction: Codes include 11971 and non-mastectomy reconstruction codes 19316, 19318, 19325. Prior authorization effective date: Oct. 1, 2022 for some codes; prior authorization not required for specified codes with qualifying DX codes (see full table).

Cancer Supportive Care (Colony-Stimulating Factors, Erythropoiesis-Stimulating Agents, Antiemetic Drugs, Bone-Modifying Agents, other oncology injectables): Multiple HCPCS/J-codes listed across entries (examples: Q5136, Q5158, J1449, J1456, J1448, J0897, Q5120, Q5108, Q5111, J2820, Q5160, J9073, J9075, J9249, J9184, J9326, J9011, J9282). Prior authorization effective dates vary (examples: Apr. 1, 2026; Oct. 1, 2023; July 1, 2023; Jan. 1, 2022; July 1, 2020; Feb. 1, 2021; July 1, 2024; Jan. 1, 2023). Many entries require prior authorization when billed with oncology diagnosis codes; some require authorization regardless of diagnosis for specific drugs. Submit oncology drug requests via the Provider Portal or call the listed prior authorization line where indicated.

Cardiology: Select CPT codes and procedures (examples noted: 33274, 33270, 33221, 33225, 33228, and angiography/diagnostic codes 93351, 93453, 93455, 93457). For certain cardiac procedures (example: 93580) prior authorization required for members age 18 and older. Prior authorization effective dates include Apr. 1, 2026 and April 1, 2022 for specific items. For details and full CPT lists visit UHCprovider.com/TXcommunityplan > Prior Authorization and Notification Resources > Cardiology Prior Authorization.

Inpatient monitoring / chemotherapy: Inpatient video EEG and inpatient chemotherapy codes listed (examples: 95726, 95720, 95724, J9011, J9282) — prior authorization is required for inpatient services. Prior authorization effective dates include Mar. 1, 2020; Jan. 1, 2020; Apr. 1, 2026. Prior authorization is not required for outpatient hospital or ambulatory surgical center services for some monitoring codes.

Outpatient chemotherapy / injectable oncology: Injectable chemotherapy and supportive oncology drugs administered in outpatient settings are listed (examples: 95718, 95722, J9184, J9326, multiple J-codes). Prior authorization effective dates vary; some agents require authorization for oncology diagnoses only, others require authorization regardless of diagnosis. Submit requests via the Provider Portal; telephone numbers provided in the full table for certain codes.

Additional oncology groups: Multiple entries list specific J-codes that require prior authorization regardless of cancer diagnosis (examples include J9056, J9059, J9259, J9323, J9350, J9294, J9297, J9048, J9314, J9394, J9298, J9332) with various effective dates (Oct. 1, 2023; July 1, 2023; May 1, 2023; Jan. 1, 2023). For some drugs (e.g., J9331, J9071, J9331 alone) prior authorization effective date Jan. 1, 2023 is noted.

Recurrent / repeated listings: The source contains repeated and fragmented entries for many of the same service groups and codes (bone growth stimulators, oncology injectables, etc.) with differing effective dates and notes; authoritative rules depend on code, date, and diagnosis gating found in the master PA table.

This fragment is incomplete. Effective dates, exact code-level applicability, and whether prior authorization is required only with specific diagnosis codes vary across entries. Consult the full Texas STAR prior authorization table on UHCprovider.com (Provider Portal Prior Authorization and Notification resources or the Texas community plan PA table) for the authoritative, up-to-date rules and the correct submission phone numbers or portal pathways.

Billing Rule

Pre-determination recommended

Pre-determination is highly recommended for drugs on the Review at Launch / New to Market Medication List; consult UHCprovider.com policies and consider pre-determination prior to providing therapy.

See Review at Launch for New to Market Medications policy at UHCprovider.com

Prior Authorization

Obtain prior authorization for listed codes

Providers must obtain prior authorization for the listed CPT/HCPCS codes under Texas STAR. Use the UnitedHealthcare Provider Portal Prior Authorization and Notification tool; for certain services (cardiology, radiology) you may also call 866-889-8054.

Portal: UHCprovider.com > Prior Authorization and Notification
Phone (cardiology/radiology and some services): 866-889-8054

Radiology portal instructions: Advanced outpatient imaging prior authorization — use UnitedHealthcare Provider Portal; examples of radiology effective dates: 77046/77047 effective Jan. 1, 2019; 76391 effective March 1, 2020; some advanced imaging entries note Jan. 1, 2024.

Sinuplasty examples: Sinuplasty codes 31295/31296 prior auth effective Aug. 3, 2015; code 31298 prior auth effective July 1, 2018.

Neurostimulator sample dates: Neurostimulator device codes (e.g., E0760, E0747, E0748, CPT 43648, 43881, 43882) include sample effective dates in fragment (E0760 Dec. 7, 2015; neurostimulator entries Jan. 1, 2015).

Documentation Required

Site-of-service review guidance

Site-of-service reviews apply to some codes (for example, CPT 69205). Prior authorization is required only when the service is requested in an outpatient hospital; use the Radiology Prior Authorization and Notification Program on the Provider Portal or call 866-889-8054.

Example: 69205 — PA required only when performed in an outpatient hospital
Submit via: UHCprovider.com > Prior Authorization and Notification (Radiology Prior Authorization and Notification Program)
Phone: 866-889-8054

43648: Code = 43648 — listed in neurostimulator section.

43881: Code = 43881 — neurostimulator related; fragment notes neurostimulator entries effective Jan. 1, 2015.

61863: Code = 61863 — listed in neurostimulator/cranial related codes.

61864: Code = 61864 — listed.

61867: Code = 61867 — listed.

61868: Code = 61868 — listed.

61885: Code = 61885 — listed.

63655: Code = 63655 — spinal/neurostimulator related listing.

63685: Code = 63685 — listed.

64568: Code = 64568 — neurostimulator lead implantation listed.

64570: Code = 64570 — neurostimulator lead implantation listed.

64590: Code = 64590 — neurostimulator related.

Where multiple effective dates appear for a code in this fragment, the dates are shown inline with the code entries (e.g., cardiology code 33274 shown with Apr. 1, 2026; many oncology J-codes show varied effective dates). Because this fragment is incomplete and duplicated, verify effective dates and any diagnosis-specific gating in the full policy on UHCprovider.com.