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Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Kentucky Only)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
Effective 2026-12-01, UnitedHealthcare Community Plan of Kentucky (Medicaid) revised its stereotactic radiation therapy (SRS and SBRT) policy so that the listed proven-and-medically-necessary indications apply only when medical necessity cannot be determined using the referenced InterQual criteria. The indication list was also revised, adding intracranial arteriovenous malformations, and the policy applies to individuals 19 years of age or older, with SRS and SBRT covered without further review for those younger than 19.
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What to do
Action · 3 steps
01By 2026-12-01: Billing team and providers should, for Kentucky Community Plan members aged 19 and older, check InterQual criteria first before scheduling SRS or SBRT for the listed indications, including intracranial arteriovenous malformations, and document how the criteria were met in the chart.
02Front desk staff should be told that members under 19 are covered without further review.
03Claims lacking supporting documentation for these indications should be reviewed before submission, since the policy states these indications are proven and medically necessary only when InterQual criteria cannot establish necessity.
Original notice
Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Kentucky Only)
uhcprovider.com · Always check the source before changing claims.