Radiation Therapy Prior Authorization Update from United Healthcare

The following is an update from UnitedHealthcare posted on December 23, 2025:

In response to recent changes by the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), beginning Jan. 1, 2026, we’re updating prior authorization requirements for certain radiology oncology CPT® and HCPCS codes.

This applies to UnitedHealthcare® Medicare Advantage Plans, UnitedHealthcare Community Plans, UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans.

Patients currently receiving radiation therapy

If prior authorization for IMRT, IGRT or Standard Radiation Therapy (2D/3D) was approved for treatment starting before Jan. 1, 2026, no new prior authorization request is needed. We’re working on a “grandfathering” effort to update all approved authorization for the termed IMRT, IGRT and Standard Radiation Therapy 2D/3D procedure codes with the updated radiation therapy procedure codes.

Patients needing radiation therapy on or after Jan. 1

For treatments starting on or after Jan. 1, 2026, submit prior authorization requests using the new AMA/CMS procedure codes for IMRT, IGRT and Standard Radiation Therapy (2D/3D) radiation therapy services.

On Jan. 1, 2026, the following codes will no longer require prior authorization:

On Jan. 1, 2026, the following procedure codes should be used for prior authorization when treating for oncologic and hematologic diagnoses:

You can review the coverage determination guidelines we use to facilitate our determinations for the radiation therapy services.

How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID. If you don’t have a One Healthcare ID, register now.
• From the left-hand tabs, select Prior Authorizations & Notifications