Outpatient radiation oncology prior authorization guideline
This administrative guideline describes which outpatient radiation oncology services are reviewed by Carelon Medical Benefits Management and explains prior authorization submission via the Carelon provider portal; it applies to providers and members under Premera Blue Cross medical benefits (not Medicare Advantage).
Added clarifying names of disorders under the broad clinical indication category names for clarity only.
Added oligometastatic extracranial disease and skin cancer to the list of radiation oncology services reviewed by Carelon Medical Benefits Management.
Coverage Criteria
Authorization requirement
Covered when prior authorization is obtained and member benefits/eligibility at time of service support coverage for the requested outpatient radiation oncology service.
Based on member benefits and eligibility at time of service
This administrative guideline does not apply to Medicare Advantage. Providers and members enrolled in Medicare Advantage plans should consult the applicable Medicare Advantage plan documents or contact the plan directly for coverage and authorization requirements.
Coding
| No codes listed |
Provider Actions & Requirements
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