Prior authorization reminder: intensity-modulated radiation therapy

In the November issue of Provider Update, CarePartners of Connecticut announced a new prior authorization requirement effective Jan. 1, 2025 for intensity-modulated radiation therapy (IMRT). As detailed in that article, a 90-day continuity of care plan was put in place for members who were in an active course of IMRT treatment prior to Jan. 1, in alignment with our Out of Network at the In Network Level of Benefit and Continuity of Care Medical Necessity Guidelines. 

We’re reminding our provider community that as of April 1, 2025, the continuity of care period has ended and a prior authorization must be obtained for the following codes for all members starting IMRT prior to their course of treatment:

• 77385
• 77386
• G6015
• G6016

For prior authorization and coverage criteria, please refer to our Intensity-Modulated Radiation Therapy Medical Necessity Guidelines.