Radiation therapy prior authorization requirement

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:

• Go to UHCprovider.com and click Sign In at the top-right corner
• Enter your One Healthcare ID and password
  • If you don’t have a One Healthcare ID, visit UHCprovider.com/access to get started
• In the menu, select Prior Authorizations
• 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
  • State: Florida

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.

Resources

Take the radiology therapy prior authorization self-paced training to learn more about the radiation therapy prior authorization submission process. You can also search the radiation and oncology therapy medical policy.

Questions?

Email unitedoncology@uhc.com or chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also call UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.

PCA-1-23-03324-Clinical-NN_10172023