Outpatient Radiation Therapy Services
Effective March 1, 2013, Empire will require prior authorization of certain non-emergency, outpatient radiation therapy services through AIM Specialty HealthSM (AIM).
For treatment plans that are scheduled to begin on or after March 1, 2013, all providers must contact AIM for prior authorization for the following non-emergency, outpatient radiation therapy modalities:
| Intensity Modulated Radiation Therapy (IMRT)|
| Proton Beam Radiation Therapy|
| Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiotherapy (SBRT) |
Radiation therapy performed as part of an inpatient admission will continue to be reviewed through Empire’s inpatient precertification process. Members currently undergoing treatment on March 1, 2013, will not be impacted.
Prior authorization will be required for all Empire members, with the exception of the following groups:
| National Accounts|
| Federal Employee Program members|
| Medicare Advantage Plans – MediBlue |
Note: Radiation therapy providers are strongly encouraged to verify that an order number has been obtained before initiating scheduling and performing services.
The list may be updated from time to time to reflect changes published by the American Medical Association in the CPT Manual.