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Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Pennsylvania Only)
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Pennsylvania revised its coverage policy for Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) effective December 1, 2026. The policy now specifies six covered indications for yttrium-90 microsphere treatment in liver cancer patients with ECOG Performance Status 0-2, replacing the previous indication list and updating clinical evidence references. Key change: "metastasis from uveal/ocular melanoma" language was revised to "metastasis from uveal melanoma."
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What to do
by Nov 30, 2026 · 5 steps
01Billing and prior authorization teams must review and update internal policy documentation to reflect the six covered TARE/SIRT indications for Pennsylvania Medicaid patients (hepatocellular carcinoma, bridge to transplant, neuroendocrine metastases, colorectal metastases, cholangiocarcinoma metastases, and uveal melanoma metastases).
02Update billing system rules to require ECOG Performance Status 0, 1, or 2 documentation for all TARE/SIRT prior authorization requests.
03Providers must document which specific indication applies on all authorization requests.
04Note: Patients under 19 years old receive coverage without prior review.
05Train clinical staff on the revised coverage criteria to prevent claim denials for cases that do not meet the new indications list.
Original notice
Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Pennsylvania Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
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