Effective April 1, 2021, prior authorization for certain outpatient radiation therapies will be required for UnitedHealthcare (UHC) commercial members. Prior authorization will be required for the following radiation therapy services, in addition to intensity-modulated radiation therapy and proton beam therapy:
- Stereotactic body radiation therapy, including stereotactic radiosurgery.
- Fractionation for breast cancer, prostate cancer, lung cancer and bone metastasis.
- Image-guided radiation therapy.
- Special and associated radiation therapy services.
- Selective internal radiation therapy, Yttrium 90 and implantable beta-emitting microspheres for treatment of malignant tumors.
If providers do not obtain prior authorization for the services identified above, claims will be denied. All requests should be submitted online using the Prior Authorization and Notification Tool. A gentle reminder as receipt of prior authorization does not guarantee claim payment. Payment for covered services is contingent upon the member’s eligibility on the date of service, reimbursement policies and the terms of the participation agreement.
American College of Radiology® staff will continue to monitor these new requirements and seek opportunities to alleviate unnecessary burdens to practices and centers offering radiation therapy services. UHC has prepared a frequently asked questions document to address common questions outlined in the new policy.
Providers offering radiation therapy services should share this information with your billing staff to ensure they have the latest information. We encourage participation in the upcoming education session identified below to get your questions answered.
Register to attend provider training offered by the UHC on Monday, April 5 at noon.
For additional questions on prior authorization requirements, contact UHC directly via email at firstname.lastname@example.org or call 1-888-397-8129.