New radiation oncology authorizations program to launch this fall

We’re partnering with EviCore on a new authorization program for outpatient radiation oncology procedures. This new program is slated to launch Sept. 15, 2024.

Why work with EviCore?

The science and evidence behind radiation oncology is rapidly evolving, and the field requires sub-specialists to provide care and service to patients. With EviCore’s expertise, we’ll be able to ensure our members get the right care at the right site at the right time.

Their process is aligned with our clinical approach by reviewing requested care and using evidence-based guidelines to make care plan decisions.

How will the program work?

You'll initiate the authorization request process in prism, as you do now. When an outpatient radiation oncology procedure requires authorization through EviCore, prism’s Request an Authorization page will automatically redirect you to EviCore’s online authorization portal.

What radiation oncology procedures will require authorization through EviCore?

Beginning this fall, the following services will require authorization through EviCore when done in an outpatient setting, for all lines of business:

Procedure type Codes requiring auth (new auth requirements in bold)
0394T, 0395T, 77761, 77762, 77763, 77767, 77768, 77770, 77772, 77778
Stereotactic radiation therapy
77371, 77372, 77373, G0339, G0340
Intensity modulated radiation therapy (IMRT)
77385, 77386, G6015, G6016
Neutron beam radiation therapy
Intraoperative radiation therapy (IORT) 77424, 77425
Proton beam radiation therapy 77520, 77522, 77523, 77255
Hyperthermia treatment 77600, 77605, 77610, 77615, 77620
Radiation treatment delivery 77401, 77402, 77407, 77412, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014
Image-guided radiation (IGRT)
77014, 77387, G6001, G6002, G6017
Therapeutic radiopharmaceuticals
77750, 79005, C2616, S2095

What's next?

In the coming weeks, we'll share additional information to ensure you have ample opportunity to be trained on using EviCore’s online authorization portal and to ask any questions you may have. Additional information will include:

  • FAQs
  • Peer-to-peer and appeals information
  • Training webinars
  • And more