Prostate Radiation Therapy - Hypofractionation - Medicare Advantage (New)

Before May 1, 2026: Billing and clinical teams must update protocols for prostate radiation therapy claims to ensure hypofractionation (20-28 fractions) is documented as preferred treatment for intermediate/high-risk cases. Update prior authorization requirements to include clinical justification if conventional fractionation (up to 45 fractions) is needed due to high-risk/node-positive cancer with pelvic node treatment, previous pelvic radiation, or prior TURP. Claims exceeding 45 fractions will be denied as medically unnecessary.