Rocky Mountain Health Plans Unveils Updated Requirements for Radiation Therapy

As of January 1, 2025, prior authorization requirements and criteria for UnitedHealthcare radiation will be implemented on Rocky Mountain Health Plans.

These changes will affect 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 the existing requirements for intensity-modulated radiation therapy and proton beam therapy.

Optum® will manage these prior authorization requests through the Cancer Guidance Program. For more information, refer to the Comprehensive Radiation Therapy Management — Training for Prior Authorization Request Submissions interactive guide.

How to Submit a Radiation Oncology Prior Authorization Request

To submit a request, follow these steps 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 can visit UHCProvider.com/access to get started.
  • From the left-hand tabs, select “Prior Authorizations and Notifications” > “Create a New Request.”
  • Choose “Radiation Oncology” from the prior authorization type dropdown.
  • Select “Rocky Mountain Health Plans” from the plan type dropdown. You will be redirected to the Optum website to complete your request.

For any inquiries, please email rmhp_updates@uhc.com.

 


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