Update: No prior authorization for some radiation therapy

Last modified: May 24, 2021

We previously announced in the March Network Bulletin that starting April 1, 2021, prior authorization for certain outpatient radiation therapies will be required for UnitedHealthcare commercial members, including:

  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley
  • UnitedHealthcare of the Mid-Atlantic, Inc.
  • MAHP Life and Health Insurance Company
  • Neighborhood Health Partners
  • UHOne
  • All Savers (fractionation prior authorization requirement for All Savers will be delayed)
  • Rhode Island and Oxford Health Plan members will be excluded

Changing prior authorization requirements

We no longer require prior authorization reviews for the following 8 radiation therapy services procedure/CPT® codes.

  • 37243
  • 61796
  • 61797
  • 61798
  • 61799
  • 61800
  • 63620
  • 63621

You can review the coverage determination guidelines we use to facilitate our determinations for the radiation therapy services.

Submitting prior authorization requests

Submit an online prior authorization request, sign in to Link to access the Prior Authorization and Notification tool. Select the “Radiology, Cardiology, Oncology and Radiation Therapy” box. After selecting “commercial” as the product type, you’ll be directed to another website to process the authorization requests.

Questions? Email unitedoncology@uhc.com.

CPT® is a registered trademark of the American Medical Association.
PCA-1-21-01512-VC-News