New streamlined radiation therapy prior authorization updates
AI Summary
Starting January 1, 2026, UnitedHealthcare is implementing new streamlined prior authorization requirements for radiation therapy services based on updated AMA/CMS procedure codes. Multiple existing IMRT, IGRT, and Standard Radiation Therapy codes will no longer require prior authorization, while new consolidated codes (77402, 77407, 77412, 77387-26) will require prior authorization for oncologic and hematologic diagnoses.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows to remove prior auth requirements for codes 77385, 77386, G6015, G6016, 77014, G6001, G6002, G6017, 77401, and G6003-G6014. Add prior authorization requirements for new codes 77402, 77407, 77412, and 77387-26 when billing for oncologic and hematologic diagnoses. Update billing system rules and notify providers of the new consolidated radiation therapy codes. Existing approvals for treatments starting before Jan 1, 2026 remain valid without new authorization.
Affected Billing Codes
Plan Types
Medicare Advantage, Medicaid, Commercial, Exchange
Specialties
oncology, radiology