Massachusetts Medicare and Medicaid: New chemotherapy and radiation prior authorization requirements via CGP

Beginning March 1, 2026, outpatient chemotherapy and radiation services for UnitedHealthcare Medicare Advantage and UnitedHealthcare Community Plan members enrolled in Massachusetts OneCare and Senior Care Options (SCO) plans will be managed through the Optum Cancer Guidance Program (CGP) and require prior authorization.

Chemotherapy services requiring prior authorization

Beginning March 1, 2026, prior authorization and notification will be required for the following outpatient chemotherapy services:

Colony-stimulating factors when requested for use to treat a cancer diagnosis
Bone modifying agent when requested for a cancer diagnosis
Select antiemetic drugs when requested for a cancer diagnosis
Injectable outpatient chemotherapy drugs

Radiation therapy services requiring prior authorization

Beginning March 1, 2026, prior authorization and notification will be required for the following radiation therapy services:

Radiation treatment delivery
Proton beam therapy
Stereotactic body radiation therapy (SBRT)
Fractions for breast, prostate, lung cancer and bone metastasis
Image guided radiation therapy (IGRT)
Special and associated radiation therapy services

Prior authorization process before March 1

From Jan. 1, 2026–Feb. 28, 2026, you can continue to use the same prior authorization process for both outpatient chemotherapy and radiation service requests.

How to submit and manage prior authorizations

Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
- If you don’t have a One Healthcare ID, register now
From the left-hand menu, select Prior Authorization & Notifications > Create a new request
Select Radiation Oncology or Oncology from the dropdown
Choose Massachusetts OneCare or Senior Care Options (SCO) Plans or enter the member’s state and plan details
You’ll be redirected to the Optum CGP platform to complete your request

Coverage and payment guidelines

An approved prior authorization does not guarantee payment. Payment is subject to member eligibility, benefit plan details, claim processing requirements and provider participation terms.

View our coverage determination guidelines for more information.