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