Affects UnitedHealthcare Preferred Care Partners and Preferred Care Network members in South Florida
Effective Jan. 1, 2024, UnitedHealthcare Medicare Advantage will require prior authorization for the following outpatient radiation therapies for UnitedHealthcare Preferred Care Partners and Preferred Care Network members:
Intensity-modulated radiation therapy (IMRT)
Proton beam therapy (PBT)
Stereotactic body radiation therapy (SBRT), including stereotactic radiosurgery (SRS)
Image-guided radiation therapy (IGRT)
Special and associated services (e.g., dosimetry and special physics consults)
Hypofractionation (fractionation) using IMRT, PBT and standard 2D/3D radiation therapy for prostate, breast, lung and bone metastasis cancers
Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting microspheres for treatment of malignant tumors
Radiation therapy is part of the Cancer Guidance Program. This program can help you manage costs, improve outcomes and increase quality of care using evidence-based guidelines.
This program does not apply to Preferred Care Partners or Preferred Care Network members who have authorizations managed by WellMed. For those members, please use the delegate's process for notification and prior authorization on the Wellmed website under the Provider Resources tab.
How to submit a radiation therapy prior authorization request
Starting Dec. 15, 2023, submit a prior authorization request through the UnitedHealthcare Provider Portal:
Scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
Select the following information:
Service type: Radiation Oncology
Product type: Medicare
Prior authorization requests submitted in December will have a treatment start date on or after Jan. 1, 2024. If we don't receive a prior authorization request before the date of service, we'll deny the claim and you won't be able to balance bill members.