Radiation therapy prior authorization for Oxford Health Plan
Effective Nov. 7, 2021, Optum will manage Oxford Health Plan prior authorization requests for outpatient radiation therapy.
For Oxford Health Plan members, we’ll require prior authorization for the following radiation therapy services, formerly managed by eviCore:
Intensity-modulated radiation therapy
Proton beam therapy
Stereotactic body radiation therapy/stereotactic radiosurgery
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
Optum will begin accepting prior authorizations submissions Nov. 1, 2021, for prior authorizations effective Nov. 7, 2021, and later.
This change will affect commercial health plan members in the Oxford Health Plan, effective Nov. 7, 2021. Any active radiation therapy prior authorizations requested up until Nov. 6, 2021, will remain in place through the former process.
A new prior authorization request will be required for radiation therapy services that start on Nov. 7, 2021 or after for specific CPT® codes.
Prior authorization for radiation therapy will be part of the comprehensive management of oncology service requests in the Cancer Guidance Program
If you already received a prior authorization for radiation therapy services in scope for prior authorization administered prior to Nov. 7, 2021, you DO NOT need to submit a new prior authorization request for that approved treatment