Radiology 

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Prior authorization

Alert: Effective 03/03/2020, the health plan is temporarily suspending the prior authorization requirement for Chest CT scans. This includes CPT code 71250, and allowable grouping CPT codes 71260 and 71270.

Required for outpatient procedures

The following outpatient radiology procedures require you to get prior authorization through NIA.

  • CT scan
  • Nuclear exercise
  • Tolerance test (ETT)
  • MRI/MRA
  • PET scan

Obtaining authorization

The ordering physician or clinic is responsible for getting authorization.

If you are providing any of the services above, you should verify that the necessary authorization has been obtained. Not having the necessary authorization could result in non-payment of your claim.

If imaging procedures are needed or performed during an emergency room and/or urgent care visit or in observation and inpatient facilities, they don't require authorization.

Additional resources