Prior Authorization for Radiation Therapy Services

This information applies only to members who are receiving radiation therapy services.

For Medicare Advantage members receiving intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) services, please see Medicare Advantage Therapeutic Radiation Prior Authorization Program.

Prior authorization requirements include the following radiation therapy modalities and services:

  • Intensity-modulated radiation therapy (IMRT)
  • Proton beam therapy (PBT)
  • Stereotactic body radiation therapy (SBRT), including stereotactic radiosurgery (SRS)
  • Image-guided radiation therapy (IGRT)
  • Special and associated services
  • Fractionation using IMRT, PBT and standard 2D/3D radiation therapy for prostate, breast,
    lung and bone metastasis cancers
  • Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting
    microspheres for treatment of malignant tumors

Prior authorization for radiation therapy services is required for members with the following coverage:

UnitedHealthcare Commercial Plans effective 04/01/2021

  • UnitedHealthcare commercial plans, excluding Indemnity/Options PPO
  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley
  • UnitedHealthcare of the Mid-Atlantic, Inc.
  • Neighborhood Health Partners
  • UHOne
  • All Savers

UnitedHealthcare Community Plan effective 10/07/2021

  • UnitedHealthcare Community Plan of California
    • Medi-Cal Managed Care
  • UnitedHealthcare Community Plan in Florida
    • Florida Healthy Kids
    • Medicaid
  • UnitedHealthcare Community Plan in Maryland
    • HealthChoice
  • UnitedHealthcare Community Plan in Mississippi
    • Mississippi Coordinated Access Network (MSCAN)
    • Mississippi Children's Health Insurance Program (MSCHIP)
    • Excludes UnitedHealthcare Dual Complete (HMO SNP)
  • UnitedHealthcare Community Plan in Ohio
    • Medicaid
  • UnitedHealthcare Community Plan in Rhode Island
    • Rhode Island Children with Special Health Care Needs
    • Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
    • Rhode Island UnitedHealthcare Rhody Health Partners
    • Rhode Island UnitedHealthcare RIte Care
  • UnitedHealthcare Community Plan in Washington
    • Apple Health
  • UnitedHealthcare Community Plan in Wisconsin
    • Badger Care

UnitedHealthcare Commercial Plans effective 11/07/2021

  • UnitedHealthcare Oxford Health Plan

We're working with Optum, our affiliate, to support you in managing the prior authorization process. Optum offers solutions to help improve the care provider experience for transactions, such as submitting prior authorization requests. Here's how to submit your request:

  1. Go to UHCprovider.com and sign in to the UnitedHealthcare Provider Portal to access the Prior Authorization and Notification tool
  2. Select the "Radiology, Cardiology, Oncology and Radiation Oncology" box
  3. Select the service type "Radiation Oncology" box
  4. After selecting commercial as the product type, you will be directed to another website to process the authorization requests

You can start the prior authorization process by calling the number on the back of the member’s ID card to provide demographic information and open the case.

For medical policies and criteria, visit UHCprovider.com/policies