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.