Effective April 1, 2021, prior authorization for certain outpatient radiation therapies will be required for UnitedHealthcare commercial members, including:
- UnitedHealthcare Plan of the River Valley, Inc.
- UnitedHealthcare Insurance Company of the River Valley
- UnitedHealthcare of the Mid-Atlantic, Inc.
- MAHP Life and Health Insurance Company
- Neighborhood Health Partners
- All Savers (fractionation prior authorization requirement for All Savers will be delayed)
Rhode Island and Oxford Health Plan members will be excluded.
You can review the coverage determination guidelines we use to facilitate our determinations for the radiation therapy services.
Effective April 1, 2021, prior authorization will be required for the following radiation therapy services, in addition to intensity-modulated radiation therapy and proton beam therapy:
- Stereotactic body radiation therapy (SBRT), including stereotactic radiosurgery (SRS)
- Fractionation for breast cancer, prostate cancer, lung cancer and bone metastasis
- Image-guided radiation therapy
- Special and associated radiation therapy services
- Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting microspheres for treatment of malignant tumors
Intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT)
- If prior authorization for these services is already approved for administered treatment prior to April 1, 2021, you do not need to submit a new prior authorization request for that approved treatment plan
Image-guided radiation therapy (IGRT), special services, Y90/SIRT or SBRT, including SRS:
- For services started between Feb. 1, 2021, and March 31, 2021, you do not need to submit a prior authorization
- For services received prior to April 1, 2021, the authorization will be effective until June 29, 2021
- For services beginning April 1, 2021, prior authorization will be required for the expanded prior authorization requirements for radiation therapy
To submit an online request for prior authorization, sign in to Link to access the Prior Authorization and Notification tool. Select the “Radiology, Cardiology, Oncology and Radiation Therapy” box. After selecting “Commercial” as the product type, you will be directed to another website to process the authorization requests.
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