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Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for New Jersey Only)
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of New Jersey (Medicaid) revised coverage criteria for Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) using yttrium-90 microspheres effective December 1, 2026. The policy now specifies five covered indications for liver cancer treatment (including a change from 'uveal/ocular melanoma metastasis' to 'uveal melanoma metastasis'), applies only to patients age 19+ with ECOG Performance Status 0-2, and automatically covers patients under 19 without prior authorization.
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What to do
Action · 6 steps
01Before December 1, 2026: Billing and clinical teams must update prior authorization protocols and claim submission guidelines for NJ Medicaid claims involving TARE/SIRT procedures.
02Update billing system to recognize five covered indications: liver-dominant primary hepatocellular carcinoma (non-surgical candidates), primary HCC as bridge to transplant, neuroendocrine tumor liver metastases (non-surgical, failed systemic therapy), chemotherapy-resistant colorectal carcinoma liver metastases with hepatic predominance, intrahepatic cholangiocarcinoma liver metastases (non-surgical candidates), and uveal melanoma metastasis confined to liver.
03Ensure all claims for covered indications include documentation of ECOG Performance Status 0, 1, or 2.
04Configure system to allow automatic approval (no prior auth required) for all patients under age 19.
05Reject or require medical necessity documentation for claims with ECOG Status 3-4 or for non-covered indications.
06Provider staff must verify patient age and clinical eligibility before claim submission.
If missed: Failure to document ECOG status or submit claims outside covered indications may result in denials.
Original notice
Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for New Jersey Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
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