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Prior Authorization for Radiation Therapy Services

This information applies only to members with the coverage listed below in the HealthPlan Effective Dates section.

Go to Prior Authorization and Notification Tool
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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 Plan effective October 7, 2021

  • UnitedHealthcare Community Plan of California
  • UnitedHealthcare Community Plan in Florida
  • UnitedHealthcare Community Plan in Maryland
  • UnitedHealthcare Community Plan in Mississippi
  • UnitedHealthcare Community Plan in Ohio
  • UnitedHealthcare Community Plan in Rhode Island
  • UnitedHealthcare Community Plan in Washington
  • UnitedHealthcare Community Plan in Wisconsin

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.

Go to Prior Authorization and Notification Tool

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.

 

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