Massachusetts Medicaid Updates Prior Authorization, HCPCS Coding, and Subscriber ID
Massachusetts Medicaid has announced major changes that will affect home health care provision under Senior Care options (SCO) and One Care plans, effective from January 1, 2026.
Updated Prior Authorization Guidelines
Under the revised policy, prior authorization will not be required for Medicaid home health services unless a member exceeds established annual benefit limits set by MassHealth. Providers will have to seek prior authorization for services exceeding the following calendar-year limits:
| Service | Annual benefit limit |
| Visits for intermittent skilled nursing and/or medication administration | 30 visits |
| Home health aide | 240 units |
| Physical or occupational therapy visits | 20 visits |
| Speech‑language therapy visits | 35 visits |
HCPCS G Code Requirement Clarified
In alignment with the Centers for Medicare & Medicaid Services (CMS) and state regulations, Massachusetts Medicaid now requires the exclusive use of HCPCS G codes for home health nursing therapy services and home health aide services that support activities of daily living.
Home health agencies are not obligated to submit individual HCPCS codes in either requesting prior authorization or submitting claims, as they are coded to the individual revenue codes and G codes within the UB bill type:
| Service | UnitedHealthcare bill type | Revenue code | G code |
| Physical therapy | UB | 0421 | G0151 |
| Occupational therapy | UB | 0431 | G0152 |
| Speech therapy | UB | 0441 | G0153 |
| Medical social services | UB | 0561 | G0155 |
| Home health aide | UB | 0572 | G0156 |
| Home health aide | UB | 0572 | G0156UD |
| Nursing services – Skilled nursing (registered nurse) | UB | 0551 | G0299 |
| Nursing services – Skilled nursing (registered nurse) | UB | 0552 | G0299UD |
| Nursing services – Skilled nursing | UB | 0551 | G0493 |
| Nursing services – Licensed practical nurse | UB | 0581 | G0300 |
| Nursing services – Licensed practical nurse | UB | 0582 | G0300UD |
How to Confirm Member ID
Some members now have new subscriber identification numbers. Using an outdated number may result in claim rejections.
You can confirm the correct subscriber identification number:
- Sign in to the UnitedHealthcare Provider Portal
- Go to Eligibility & Benefits and search by date of birth and name.
- Select Multiple Policies to review all active coverages and confirm the new Subscriber ID.
You can request the updated policy number directly from the member.
If you have questions, you can connect to chat 24/7 in the UnitedHealthcare Provider Portal.
