Radiation therapy authorization requirements for Medicaid
Effective Oct. 7, 2021, prior authorization will be required for the following outpatient radiation therapies forUnitedHealthcare Community Plan Medicaid members.
Intensity modulated radiation
Stereotactic body radiation therapy
Fractionation for breast cancer, prostate cancer, lung cancer and bone metastasis
Image guided radiation therapy
Special and associated radiation therapy services
Implantable beta emitting microspheres (Y90)
Prior authorization will be required forUnitedHealthcare Community Plan members in:
Also starting Oct. 7, 2021, prior authorization requests for these noted outpatient radiation therapies and the existing prior authorization requirement for proton beam therapy (PBT) will be managed by Optum.
How to submit prior authorization
For proton beam therapy (PBT),if prior authorization for these services is already approved for administered treatment prior to Oct. 7, 2021, you do not need to submit a new prior authorization request for that approved treatment plan.
For intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), special services Y90/SIRT or SBRT, including SRS services started between Aug. 1–Oct. 6, 2021, you do not need to submit a prior authorization request. We’ll authorize the radiation therapy service(s) the member was receiving prior to Oct. 7, 2021, and the authorization will be effective for 90 days from the treatment start date. Any further radiation therapy services that extend after 90 days from the treatment start date prior authorization would be required prior to the start of services.