This policy change applies to UHC Commercial Plans:
- 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
If you are a provider seeing any of the patients with the above mentioned plans and refer them for some outpatient radiotherapies, then this change applies to you.
There are 8 Radiotherapy codes, when performed in outpatient setting will no longer require a prior authorization.
These codes are:
- 37243-Vascular embolization or occlusion, for tumors, organ ischemia, or infarction
- 61796-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion
- 61797-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion
- 61798-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 complex cranial lesion
- 61799-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, complex
- 61800-Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure)
- 63620-Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion
- 63621-Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)
If you would like to read the full coverage of determination, please click here.
If you are a provider that is ordering other types of outpatient radiotherapy, please ubmit 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.
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