Mandatory Pre-approval for Stereotactic Radiosurgery and Related Radiation/Chemotherapy Treatments
This notice governs mandatory pre-approval (pre-authorization) requirements for specified stereotactic radiosurgery CPT/HCPCS codes and related radiation therapy treatments for Culinary Health Fund members; it affects providers who furnish these services to plan members.
No material clinical or coverage changes in this revision.
Pre-approval / Coverage Criteria
Pre-approval criteria
Pre-approval requirement for listed procedures; reimbursement may be delayed or denied if treatment plans are not submitted prior to services.
ALL of the following
- Proposed treatment plans for the services billed with the listed CPT/HCPCS codes must be submitted to American Health Holdings, Inc. (AHH) prior to services being rendered.
- Submission must be made via AHH toll-free number 866-330-2307 or website www.americanhealthholdings.com.
- Pre-approval requests for the listed services will be reviewed by an oncology specialist at AHH.
- Failure to submit treatment plans prior to services may result in reimbursement for treatment being delayed or denied.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.