This content applies to Medicare Advantage and UnitedHealthcare Dual Special Needs Plan (DSNP).
Notification for Outpatient Injectable Chemotherapy
Starting March 1, 2018, we will require care providers to submit a notification for injectable chemotherapy for members located in Florida and Georgia ‒ including intravenous, intravesical and intrathecal ‒ when it is administrated in an outpatient setting for members with a cancer diagnosis. Notification will apply to members in the following Medicare Advantage plans:
- AARP® MedicareComplete®
- Care Improvement Plus®
- UnitedHealthcare Dual Complete®
- UnitedHealthcare® Group Medicare Advantage retiree plans
Beginning April 1, 2018, care providers will have the same notification requirement for UnitedHealthcare Medicare members in Wisconsin.
Injectable chemotherapy drugs that require notification:
- Chemotherapy injectable drugs (J9000 - J9999), Leucovorin (J0640), Levoleukovorin (J0641)
- Chemotherapy injectable drugs that have a Q code
- Chemotherapy injectable drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code will require prior authorization
- All outpatient injectable chemotherapy drugs started after the chemotherapy notification effective date
Under the Outpatient Injectable Chemotherapy Program, notification is not required for:
- Radio-therapeutic agents (e.g., Zevalin and Xofigo)
- Oral chemotherapy drugs
- Use of chemotherapy drugs for non-cancer diagnosis
- Supportive care drugs including but not limited to colony-stimulating factors
Note: Adding a new injectable chemotherapy drug to a regimen will require a new notification.
Submitting Your Notification
How to Submit an Injectable Chemotherapy Notification For UnitedHealthcare Medicare members:
We request that you attempt to submit and complete all notifications for injectable chemotherapy online. It’s easier for you and will save you time rather than completing the notification request by phone. To access the Prior Authorization Notification app, click the button below. From the app, select Oncology.
If you have questions about notifications for UnitedHealthcare members, please call 866-889-8054, 7 a.m. to 7 p.m., local time, Monday through Friday.
- Notification for Outpatient Injectable Chemotherapy for Medicare Advantage Plans FAQs
- UnitedHealthcare Chemotherapy Prior Authorization Program - Cancer Diagnosis Reference
- UnitedHealthcare Chemotherapy Prior Authorization Program - Case Status Definitions
If you have program questions and need more information, please email firstname.lastname@example.org.