This information applies only to Commercial members who are receiving Intensity Modulated Radiation Therapy (IMRT) services.
For Medicare Advantage members receiving IMRT, stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) services, please see Medicare Advantage Therapeutic Radiation Prior Authorization Program.
Prior Authorization for Intensity Modulated Radiation Therapy (IMRT) services is required for members of the following Commercial health plans:
While you can begin the prior authorization process by fax, phone or online, we recommend that you use the fax or online method for the quickest turnaround time.
Using the appropriate IMRT Clinical Cover Sheet and IMRT Treatment Request Form can provide us the clinical information that we need to process the authorization.
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.
You may request an urgent review for an Intensity Modulated Radiation Therapy (IMRT) if the member's clinical symptoms as listed by the radiation oncologist require emergent treatment within 48 hours.
If you are requesting IMRT for a UnitedHealthcare member* as part of a clinical trial, please submit your request to the Oncology Clinical Trial Review team in one of the following ways:
We review all requests specific to both the clinical trial and the member's coverage document, which may cover the costs of routine care, but not the investigational item, device or service. We’ll notify you of the review outcome in writing.
*For members of Neighborhood Health Partnership and UnitedHealthcare Plan of the River Valley, please call the member service number on the back of the member's ID card to request coverage for IMRT clinical trials.