January 01, 2022

Exchange plans: Prior authorization updates for radiation and chemotherapy services

Starting April 1, 2022, certain radiation therapy and chemotherapy services will require prior authorization for Individual Exchange plans in the following states:

  • Alabama
  • Arizona
  • Florida
  • Georgia 
  • Illinois
  • Louisiana
  • Maryland
  • Michigan
  • North Carolina
  • Oklahoma
  • Tennessee
  • Texas
  • Virginia
  • Washington

Optum, a UnitedHealthcare affiliate, will manage the prior authorization process for these services.

See below for the list of radiation therapy codes that will require prior authorization. For the list of chemotherapy codes, see our Advance Notification and Plan Requirement Resources.

Register for upcoming training
We’re offering 1-hour training sessions to review the new prior authorization request process and the online tool you’ll use to submit your requests. Use the following links to register:

  • Radiation therapy services: Wednesday, March 23, 11 a.m.–12 p.m. CT Register here
  • Chemotherapy services: Monday, March 28, 12–1 p.m. CT Register here

The online prior authorization tool will be available starting April 1, 2022. All approved prior authorization requests for chemotherapy or radiation therapy with a start date of April 1, 2022, or later will continue to be valid through their end date. 

Questions?
Email unitedoncology@uhc.com.

CPT® code Description

77014

Computed tomography guidance for placement of radiation therapy fields

77331

Special dosimetry (e.g., TLD, microdosimetry) (specify), only when prescribed by the treating physician

77370

Special medical radiation physics consultation

77373

SBRT, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions

77387

Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

77399

Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services

77470

Special Treatment Procedure (e.g., total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation

77401

Radiation treatment delivery, superficial and/or ortho voltage, per day

77402

Radiation treatment delivery, =>1 MeV; simple

77407

Radiation treatment delivery, =>1 MeV; intermediate

77412

Radiation treatment delivery, =>1 MeV; complex

79445

Radiopharmaceutical therapy, by intra-arterial particulate administration

G6001

Ultrasonic guidance for placement of radiation therapy fields

G6002

Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy

G6003

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev

G6004

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6–10 mev

G6005

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11–19 mev

G6006

Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater

G6007

Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev

G6008

Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6–10 mev

G6009

Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11–19 mev

G6010

Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater

G6011

Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev

G6012

Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6–10 mev

G6013

Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11–19 mev

G6014

Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater

G6017

Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3d positional tracking, gating, 3d surface tracking), each fraction of treatment

S2095

Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres

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