Radiation and Oncologic Procedures | UHC Coverage Update

TL;DR: UnitedHealthcare modified its Radiation and Oncologic Procedures Medicare Advantage coverage policy, effective March 2, 2026. The update adds explicit criteria for TARE/SIRT, TAE/TACE, proton beam therapy, and stereotactic procedures — and your billing team needs to know exactly which codes and criteria apply before submitting claims.

UnitedHealthcare updated its Medicare Advantage medical policy covering radiation and oncologic procedures, with an effective date of March 2, 2026. This policy governs CPT codes 77371, 77372, 77373, 77520, 77522, 77523, 77525, 79445, 37243, and HCPCS codes G0339 and G0340, among others. The radiation oncology billing implications are significant for oncology practices, hospital-based radiation departments, and interventional radiology teams billing under Medicare Advantage plans.

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Quick-Reference Table

Field	Detail Copy
Payer	UnitedHealthcare (Medicare Advantage)
Policy	Radiation and Oncologic Procedures – Medicare Advantage Medical Policy
Policy Code	radiation-oncologic-procedures
Change Type	Modified
Effective Date	2026-03-02
Impact Level	High
Specialties Affected	Radiation Oncology, Interventional Radiology, Neurosurgery, Medical Oncology
Key Action	Audit charge capture and prior authorization workflows for TARE/SIRT, TAE/TACE, proton beam, and SRS/SBRT codes before March 2, 2026

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UnitedHealthcare Radiation Oncology Coverage Criteria and Medical Necessity Requirements 2026

This coverage policy layers UnitedHealthcare's own criteria on top of Medicare's existing National Coverage Determination for Therapeutic Embolization (NCD 20.28). There are no Local Coverage Determinations or Local Coverage Articles governing these services — no MAC-level rules to check. UnitedHealthcare fills that gap with its own supplemental criteria.

The real issue here is that UnitedHealthcare explicitly states it uses its criteria to prevent both incorrect denials and incorrect approvals. That's a two-sided standard. Your team needs to document medical necessity precisely, because an underdocumented claim fails on both ends.

TARE/SIRT: Implantable Beta-Emitting Microspheres

For transarterial radioembolization (TARE) and selective internal radiation therapy (SIRT), UnitedHealthcare ties its Medicare Advantage coverage policy to its commercial policy: the UnitedHealthcare Commercial Medical Policy titled "Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver."

The primary CPT codes affected are 37243 (vascular embolization or occlusion, inclusive of all radiological supervision and interpretation) and 79445 (radiopharmaceutical therapy by intra-arterial particulate administration). UnitedHealthcare applies its commercial criteria to supplement NCD 20.28 when reviewing these claims under Medicare Advantage.

Medical necessity documentation must show the procedure is appropriate for the individual — not just appropriate in general. UnitedHealthcare specifically calls out risks: radiation damage to the lungs, stomach or intestinal ulcers, gallbladder injury, kidney damage, and fluid around the lungs. Your documentation should address why these risks are acceptable for this specific patient.

TAE/TACE: Transarterial Therapy of the Liver

For transarterial bland embolization (TAE) and transarterial chemoembolization (TACE), UnitedHealthcare supplements NCD 20.28 with InterQual CP: Procedures, Ablative or Transarterial Therapy, Liver criteria. These are the same CPT codes — 37243 and 79445 — but the clinical criteria reference InterQual rather than the commercial TARE/SIRT policy.

This distinction matters. If your team bills 37243 or 79445 for TACE versus SIRT, the criteria set UnitedHealthcare applies to review the claim differs. Verify which procedure was performed and document accordingly. Mixing these up on a claim or in the chart is an easy path to a claim denial.

Proton Beam Therapy

Proton beam therapy (PBT) is covered under this policy through CPT codes 77520 (simple, without compensation), 77522 (simple, with compensation), 77523 (intermediate), and 77525 (complex). UnitedHealthcare's medical necessity review for proton beam therapy uses criteria specific to PBT indications.

PBT prior authorization is notoriously high-scrutiny under Medicare Advantage plans. Confirm your prior auth workflow accounts for PBT before the March 2, 2026 effective date.

Stereotactic Radiosurgery and SBRT

SRS and SBRT coverage applies to CPT codes 77371, 77372, 77373, and HCPCS codes G0339 and G0340. CPT 77371 covers SRS using multi-source Cobalt-60 (Gamma Knife). CPT 77372 covers SRS using a linear accelerator. CPT 77373 covers stereotactic body radiation therapy (SBRT) per fraction.

HCPCS G0339 covers a complete course of image-guided robotic linear accelerator-based SRS. HCPCS G0340 covers individual delivery sessions under the same system. Know which code applies to your equipment and delivery method — the distinction between G0339 and G0340 is especially important for Cyberknife billing.

Image-Guided Radiation Therapy

CPT 77387 (guidance for localization of target volume for radiation treatment delivery, including intrafraction tracking) is covered under the IGRT group. This code is an add-on to treatment delivery and requires documentation that image guidance was performed and used for localization.

Radiation Treatment Delivery Levels

CPT codes 77402 (Level 1), 77407 (Level 2), and 77412 (Level 3) apply when reported for covered indications. Level 2 and Level 3 delivery codes connect to CPT 77301 (intensity modulated radiotherapy plan, including dose-volume histograms). If you bill 77301 for IMRT planning, the treatment delivery codes reported alongside it must match the documented complexity level.

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Coverage Indications at a Glance

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UnitedHealthcare Radiation Oncology Billing Guidelines and Action Items 2026

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Radiation and Oncologic Procedures Under radiation-oncologic-procedures

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Covered HCPCS Codes (When Medical Necessity Criteria Are Met)

Code	Type	Description	Policy Group Copy
G0339	HCPCS	Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy	Stereotactic Radiosurgery/SBRT
G0340	HCPCS	Image guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging	Stereotactic Radiosurgery/SBRT

Note: No ICD-10-CM diagnosis codes are specified in this policy document. Diagnosis code requirements follow NCD 20.28 and the applicable InterQual or UHC commercial criteria referenced in the policy.

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