MedicaidPrior AuthMedium impact
Xofigo® (radium Ra 223 dichloride) (New)
Humana·IN · Oncology, Nuclear Medicine, Radiation Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has issued a new Prior Authorization policy for Xofigo® (radium Ra 223 dichloride) effective for Medicaid Indiana members. This is a radioactive therapeutic agent used in oncology that now requires prior authorization before administration. Billing teams must implement authorization requirements immediately to avoid claim denials.
Action Required
Immediately: Billing team must contact Humana at the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5f8) to obtain the complete policy details including specific HCPCS codes for Xofigo® administration, prior authorization procedures, and documentation requirements. Update billing software to flag all Xofigo® claims for Medicaid Indiana members requiring prior authorization before submission. Notify oncology providers and nuclear medicine staff that Xofigo® administration now requires preapproval. Add prior authorization requirement to treatment planning workflows. Failure to obtain prior authorization will result in claim denials for Medicaid Indiana members. NOTE: This policy summary lacks specific billing codes and effective date details—retrieve the complete policy document immediately to implement fully.