Prior Authorization for Radiation Therapy Services

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

UnitedHealthcare Commercial Plans - Effective April 1, 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 Plans

• UnitedHealthcare Community Plan in Florida – Effective October 7, 2021
  
• UnitedHealthcare Community Plan in Maryland – Effective October 7, 2021
• UnitedHealthcare Community Plan of Minnesota – Effective February 1, 2023
• UnitedHealthcare Community Plan in Mississippi – Effective October 7, 2021
• UnitedHealthcare Community Plan in New Jersey – Effective July 1, 2022
• UnitedHealthcare Community Plan in Ohio – Effective October 7, 2021
• UnitedHealthcare Community Plan in Rhode Island – Effective October 7, 2021
• UnitedHealthcare Community Plan of Virginia – Effective February 1, 2023
• UnitedHealthcare Community Plan in Washington – Effective October 7, 2021
• UnitedHealthcare Community Plan in Wisconsin – Effective October 7, 2021

UnitedHealthcare Commercial Plans - Effective November 7, 2021

• UnitedHealthcare Oxford Health Plan

UnitedHealthcare Commercial Plans - Effective April 1, 2022

• UnitedHealthcare Value and Balance Exchange Plans

UnitedHealthcare® Medicare Advantage, UnitedHealthcare West Medicare Advantage and UnitedHealthcare Community Plan (Dual Special Needs Plan) health plans effective June 7, 2022

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

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 "Radiology, Cardiology, Oncology and Radiation Oncology Transactions”
3. Select the service type "Radiation Oncology"
4. Select the product type of Commercial, Exchanges, Medicaid, Medicare, or Oxford

Or call 888-397-8129 from 8 a.m. – 5 p.m. local time, Monday -Friday.

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

You can print radiation oncology clinical worksheets after signing into the UHCprovider.com/Prior Authorization and Notification tool. 

Select “Radiology, Cardiology, Oncology and Radiation Oncology Transactions”

Select the service type of “Radiation Oncology” and any of the product types

You will then be redirected to the MBMNow website.

You can print radiation oncology clinical worksheets by navigating to the “Contact Us” tab from the MBMNow homepage.

Open the “User Guide” to view and access worksheets by primary diagnosis/cancer type

Select “Link to Worksheets”

The worksheets are sorted in alphabetical order by primary diagnosis/cancer type. Scroll to the desired section and print the appropriate page(s) as needed.