Medicare Advantage Therapeutic Radiation Prior Authorization Program

This content applies to Medicare Advantage and UnitedHealthcare Dual Special Needs Plan (DSNP).

The prior authorization information on this page is effective as of January 1, 2017.  It applies only to Medicare Advantage members who are receiving intensity modulated radiotherapy (IMRT), stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT) treatment.

For Commercial members receiving IMRT services, please see the Commercial Intensity Modulated Radiation Therapy Prior Authorization Program.

Important Reminders

• If you don't have a required prior authorization before administering IMRT, SRS or SBRT services, your claim may be denied. Please remember that members can't be billed for claims that are denied because you didn't have prior authorization.
• If you have questions about the member's benefits, please contact the care provider service phone number on the back of the member's ID card. For prior authorization questions, please call the UnitedHealthcare Clinical Request Line at 866-889-8054.
• Having a prior authorization or pre-determination on file does not guarantee or authorize payment. Payment for covered services depends on the member's benefit plan and eligibility on the date of service, care provider eligibility for payment, claim processing requirements and the care provider participation agreement. Post-service determinations may still apply based on criteria published in medical policies as well as local and national coverage determination criteria. For these requirements, please see UnitedHealthcare Medicare Advantage Coverage Summaries.

Helpful References

• Commercial Medical & Drug Policies and Coverage Determination Guidelines
  
• Medicare Advantage Therapeutic Radiation - Coding Guidelines (Codes Requiring Prior Authorization)
• Medicare Advantage Radiation Therapy Prior Authorization Frequently Asked Questions