Radiation Therapy Authorization Program

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In an effort to help ensure that the radiation oncology therapy services provided to our members are consistent with nationally recognized clinical guidelines, Highmark has contracted with eviCore healthcare to provide medical necessity review and authorization where applicable for select radiation oncology therapy services.

Reference Materials

December, 2011 Special Bulletin
Read the Special Bulletin about the Highmark Radiation Therapy Authorization Program.
Frequently Asked Questions
Read the updated FAQs about the Radiation Therapy Authorization Program.
Administrative Guide
This guide includes a summary of all components of the Radiation Therapy Authorization Program and includes the list of procedure codes that require authorization.
Radiation Oncology Provider Pathways Program - Administrative Guide
This guide will assist providers with meeting or exceeding the metrics to qualify for the Radiation Oncology Provider Pathways Program.
Radiation Oncology Provider Pathways Reconsiderations Form
RT Clinical Guidelines

Last updated on 11/22/2022 9:50:49 AM

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

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Reference Materials

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