New Jersey Medicaid: Radiation therapy prior authorization updates effective July 1
Effective July 1, 2022, prior authorization will be required for the following outpatient radiation therapies forUnitedHealthcare New Jersey Community Plan Medicaid members:
Intensity modulated radiation therapy (IMRT)
Stereotactic body radiation therapy (SBRT)
Fractionation intensity-modulated radiation therapy (IMRT), proton beam therapy (PBT) and standard 2D/3D radiation therapy for breast cancer, prostate cancer, lung cancer and bone metastasis
Image -guided radiation therapy (IGRT)
Special and associated radiation therapy services
Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting microspheres for treatment of malignant tumors
Prior authorization management change As part of the new prior authorization requirement, we are also changing the way we manage requests.
Starting July 1, 2022, prior authorization requests for the above-noted outpatient radiation therapies and the existing prior authorization requirement for PBT will be managed by Optum®.
How to submit prior authorization For PBT, if prior authorization for these services is already approved for administered treatment prior to July 1, 2022, you do not need to submit a new prior authorization request for that approved treatment plan.
For IMRT, standard radiation therapy 2D/3D, IGRT, special services, Y90/SIRT or SBRT, including SRS services started between May 1, 2022 and June 30, 2022, you do not need to submit a prior authorization request. We’ll authorize the radiation therapy service(s) the member was receiving prior to July 1, 2022 and the authorization will be effective for 90 days from the treatment start date. For any further radiation therapy services that extend after 90 days from the treatment start date, prior authorization would be required before the start of services.