New radiation therapy requirements for Rocky Mountain Health Plans
Beginning Jan. 1, 2025, UnitedHealthcare radiation prior authorization requirements and criteria will apply to Rocky Mountain Health Plans.
These changes will apply to the following Rocky Mountain Health Plans:
- Colorado Doctor’s Plan
- Monument Health HMO
- Monument ONE
- Rocky Mountain Valley Plans
- Medicaid PRIME and CHIP+
- Medicare Advantage
- Dual Eligible Plans
Radiation prior authorization/notification requirements
The plans will require prior authorization/notification for the following radiation therapy services:
- Stereotactic body radiation therapy
- Fractions for breast cancer, prostate cancer, lung cancer and bone metastasis
- Image-guided radiation therapy
- Special and associated radiation therapy services
The corresponding codes include:
| RadOnc 40 Dx codes | |||
|---|---|---|---|
| G6001 | G6011 | 77014 | 77401 |
| G6002 | G6012 | 77331 | 77402 |
| G6003 | G6013 | 77370 | 77407 |
| G6004 | G6014 | 77371 | 77412 |
| G6005 | G6015 | 77372 | 77470 |
| G6006 | G6016 | 77373 | 77520 |
| G6007 | G6017 | 77385 | 77522 |
| G6008 | S2905/55874 MR only | 77386 | 77523 |
| G6009 | G0339 | 77387 | 77525 |
| G6010 | G0340 | 77399 | 79445 |
This change is in addition to already required intensity-modulated radiation therapy and proton beam therapy.
Optum® will manage these prior authorization requests through the Cancer Guidance Program. For more information, see our Comprehensive Radiation Therapy Management — Training for Prior Authorization Request Submissions interactive guide.
How to submit a radiation oncology prior authorization request
You can submit a request through the UnitedHealthcare Provider Portal:
- From any page on UHCprovider.com, select Sign In at the top-right corner
- Enter your One Healthcare ID
- New users who don’t have a One Healthcare ID: Visit UHCProvider.com/access to get started
- From the left-hand tabs, select Prior Authorizations and Notifications > Create a new request
- Select Radiation Oncology from the prior authorization type dropdown
- Select Rocky Mountain Health Plans from the plan type dropdown. You’ll be directed to the Optum website to complete your request.
Questions?
If you have questions, please email rmhp_updates@uhc.com.
PCA-1-24-02712-Clinical-NN_09162024
