Oregon CPT Preapproval Grid
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- Pamela Morgan Arnold
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1 Not Applicable Home Health Stays - For all Initial Certification and Recertification periods Notes: Initial Certification review required effective 1/1/12. Not Applicable Skilled Nursing Facility Stays Excision benign lesion Blepharoplasty Notes: If Opthamologist requesting, pre-auth is not required Breast repair or reconstruction Mammaplasty, augmentation with or without prosthetic implant Notes: If breast cancer diagnosis, pre-auth is not required Breast repair or reconstruction Electrical stimulation non-invasive Electrical stimulation operative Low intensity ultrasound (US) for bone stimulation Spinal procedures Spinal procedures Spinal procedures Arthrodesis Lung transplant procedures Heart/lung transplant Page 1 of 6
2 Endovenous Ablation Therapy Treatment of varicose veins Laparoscopic Gastric Bypass with Small Bowel Resection Other Laparoscopic Gastric Procedures Laparoscopic Bariatric Procedures Open Bariatric, Gastric Procedures Intestine transplant procedures Colonoscopy Notes: < 50 years of Age (>50 does not require authorization) Pancreas Transplant Hernia repair Laparoscopy Kidney Transplant Circumcision procedures, frenulotomy of penis Plastic surgery on penis; insertion and repair of prosthesis Plastic repair of introitus, clitoroplasty, perineoplasty Hysterectomy, abdominal and vaginal enterocele repair Vaginal hysterectomy Page 2 of 6
3 Vaginal hysterectomy with laparoscopy Unlisted laparoscopy procedures, uterus Laparoscopy/Lysis of Adhesions Laparoscopy/Lysis of Adhesions Oophrectomy/Laparotomy Neurolysis & Injection/Aspiration of Spine, Diagnostic/Therapeutic Injection/Infusion Diagnostic/Therapeutic Material Procedures Related to Epidural and Interthecal Catheters Posterior Midline Laminectomy/Laminotomy/Decompression & Cervical Laminoplassty Procedures Spinal cord procedures Spinal Neurostimulation Transforaminal Injection Injection(s), diagnostic or therapeutic agent, Paravertebral Facet Joint Nerve; Lumbar Or Sacral Peripheral nerve neurostimulators Peripheral nerve neurostimulators Peripheral nerve neurostimulators Page 3 of 6
4 Peripheral nerve neurostimulators Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve; Lumbar Or Sacral Corneal transplant Implantation of hearing device Cochlear implant & unlisted Magnetic Resonance Imaging (MRI) Temporomandibular Joint Notes: If for dentofacial anomalies, osteoarthrosis, dislocation of jaw, pre-auth is not required Magnetic Resonance Imaging (MRI) Orbit, Face, or Neck Magnetic Resonance Angiography (MRA) Head and Neck Magnetic Resonance Imaging (MRI) Brain Magnetic Resonance Imaging (MRI) Chest Magnetic Resonance Angiography (MRA) Thorax Magnetic Resonance Imaging/Magnetic Resonance Angiography (MRI/MRA) spinal canal Magnetic Resonance Imaging (MRI) Pelvis Magnetic Resonance Angiography (MRA) Pelvis Magnetic Resonance Imaging (MRI) Upper Extremity Magnetic Resonance Angiography (MRA) Shoulder, Arm, Hand Magnetic Resonance Imaging (MRI) Lower Extremity Page 4 of 6
5 Magnetic Resonance Angiography (MRA) Leg, Ankle, Foot Magnetic Resonance Imaging (MRI) Abdomen - General Magnetic Resonance Angiography (MRA) Abdomen-General Magnetic Resonance Imaging (MRI) Heart Structure and Physiology Magnetic Resonance Spectroscopy Unlisted Ultrasound Procedure Magnetic Resonance Imaging (MRI) breast Magnetic Resonance Imaging (MRI) Bone Marrow Blood Supply Nuclear cardiac testing Heart Positron Emission Tomography (PET) Brain Positron Emission Tomography (PET) Tumor Positron Emission Tomography (PET) Genetic Testing Biofeedback Biofeedback Gastrointestinal tract imaging, eg capsule endoscopy Speech/language services Page 5 of 6
6 Speech/language services Unlisted neurological or neuromuscular diagnostic procedure Health and Behavior Assessment and Intervention Notes: Pre-auth required for units > 10 per member per year Physical medicine & rehabiliation Medical Nutrition Therapy Notes: If diabetes diagnosis, pre-auth is not required Chiropractic manipulation Hyperbaric Page 6 of 6
Oregon CPT Preapproval Grid
* The following grid only identifies items that require preapproval from. 11400-11471 Excision benign lesion 15820-15823 Blepharoplasty Notes: If Opthamologist requesting, pre-auth is not required 19316-19318
2016 MDwise Excel Network Hoosier Healthwise Medical Services that Require Prior Authorization
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ADI Procedure Codes. August 2016 Revised April 2017 Page 1 of 7 ADI Procedure Codes
Code Description 70450 CT Head without contrast 70460 CT Head with contrast 70470 CT Head with & without contrast 70480 CT Orbit, et al without contrast 70481 CT Orbit, et al with contrast 70482 CT Orbit,
AMERICAN IMAGING MANAGEMENT
2012 CPT Codes Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o 74160 CT abdomen; with 74170 CT abdomen; w/o followed by Chest 71250 CT thorax; w/o 71260 CT thorax; with 71270
AMERICAN IMAGING MANAGEMENT
2010 BCBS of Georgia CPT Codes With Grouper Numbers Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o contrast 6 74160 CT abdomen; with contrast 74170 CT abdomen; w/o contrast
MDwise Community Health Network Hoosier Healthwise Medical Services that Require Prior Authorization
MDwise Community Health Network Hoosier Healthwise Medical Services that Require Prior Authorization Medical services that require Prior Authorization Type of Service Requires PA Coding All Out of Network
05/02/ CPT Preauthorization Groupings Effective May 2, Computerized Tomography (CT) Abdomen 6. CPT Description SEGR CT01
Computerized Tomography (CT) 6 & 101 5 Upper Extremity 11 Lower Extremity 12 Head 3 Orbit 1 Sinus 2 Neck 4 7 Cervical Spine 8 Thoracic Spine 9 Lumbar Spine 10 Colon 13 CPT Preauthorization Groupings CPT
screening; including image post processing CT, heart; without contrast material; with Requires authorization
0042T Cerebral perfusion analysis using CT; with ; including of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time 74263 Computed tomographic (CT) colonography,
Diagnostic Imaging Utilization Management and Consultation Management Programs Imaging Code Listing for Connecticut, Maine and New Hampshire
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Radiology Codes Requiring Authorization*
70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 70450 Computed tomography, head or brain; without contrast material 70460 Computed tomography, head or brain; with contrast material(s)
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Prior Authorization List Effective February 2, 2015
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Jan 30, Dear Provider:
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Prior Authorization List for Physician Alliance of the Rockies, UnitedHealthcare Medicare Advantage Effective January 1, 2019
MEDICAL MANAGEMENT CONTACT INFO- MONDAY - FRIDAY FROM 8:00 AM TO 5:00 PM - (720) 445-9404 *ALL REFERRALS TO SPECIALISTS REQUIRE PRIOR AUTHROIZATION* *ALL OUT OF NETWORK SERVICES REQUIRE PRIOR AUTHROIZATION*
Diagnostic Imaging Prior Review Code List 2 nd Quarter 2018
Computerized Tomography (CT) Abdomen 6 Abdomen/Pelvis Combination 101 Service 74150 CT abdomen; w/o 74160 CT abdomen; with 74170 CT abdomen; w/o followed by 74176 Computed tomography, abdomen and pelvis;
AIM 2014 CPT Radiology & Cardiac Codes Requiring Review
AIM 2014 CPT Radiology & Cardiac Codes Requiring Review Modality Body Part CT Head 1 70480 CT orbit, sella or posterior fossa; w/o contrast 1 CT Head 1 70481 CT orbit, sella or posterior fossa; with CT
Cigna - Prior Authorization Procedure List: Radiology & Cardiology
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2012 CPT Radiology Codes Requiring Review Blue Cross and Blue Shield of Louisiana
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Prior Authorization List for Physician Alliance of the Rockies, UnitedHealthcare Medicare Advantage Effective April 1, 2018
Prior List for Physician Alliance of MEDICAL MANAGEMENT CONTACT INFO- MONDAY - FRIDAY FROM 8:00 AM TO 5:00 PM - (720) 445-9404 *ALL REFERRALS TO SPECIALISTS REQUIRE PRIOR AUTHROIZATION* *ALL OUT OF NETWORK
MOLINA HEALTHCARE OF MICHIGAN PRIOR AUTHORIZATION / PRE-SERVICE REVIEW GUIDE IMAGING CODES REQUIRING PRIOR AUTHORIZATION EFFECTIVE 1/1/2014
70336 MRI MRI, temporomandibular joint(s) 70450 CT/CTA CT, head or brain; without contrast material 70460 CT/CTA CT, head or brain; with contrast material(s) 70470 CT/CTA CT, head or brain; without contrast
22110 vertebral segment; cervical vertebral segment; thoracic vertebral segment; lumbar
The following codes are authorized by Palladian Health for applicable product lines. Visit palladianhealth.com to request authorization and to access guidelines. Palladian Musculoskeletal Program Codes
2014 CPT Radiology Codes Requiring Review
CT Head 1 70480 CT orbit, sella or posterior fossa; w/o contrast 1 CT Head 1 70481 CT orbit, sella or posterior fossa; with CT orbit, sella or posterior fossa; w/o contrast CT Head 1 70482 followed by
PHC TAR REQUIREMENTS
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BlueAdvantage SM. & BlueChoice SM Radiology Prior Authorization Program Code List CPT /HCPS
BlueAdvantage SM & BlueChoice SM Radiology Prior Authorization Program Code List CPT /HCPS 70336 MRI TMJ 70450 CT Head Without Contrast 70460 CT Head With Contrast 70470 CT Head Without & With Contrast
SUPPLEMENTAL DIGITAL CONTENT 2 : SURGERY SUBGROUPS DEFINITONS AND DISTRIBUTION
mortality 24h in ICU mortality 24h in ICU 1 SUPPLEMETAL DIGITAL COTET 2 : SURGERY SUBGROUPS DEFIITOS AD DISTRIBUTIO =2,717,902 GHM codes* Surgery description CARDIAC SURGERY 05C021 to 05C034 Cardiac valve(s)
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2010 Radiology Prior Authorization List for UnitedHealthcare s HealthChoice Members
70336 MR TEMPOROMANDIBULAR JOINT 70450 CT, HEAD OR BRAIN; WITHOUT MATERIAL 70460 CT HEAD/BRAIN W/ 70470 CT HEAD/BRAIN W/O & W/ 70480 CT, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MID 70481 CT ORBIT W/
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HIP RADIOLOGY PROGRAM CODE LISTS
EFFECTIVE OCTOBER 1, 2012 70336 MAGNETIC RESONANCE IMAGING TMJ 70450 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT 70460 COMPUTED TOMOGRAPHY HEAD/BRAIN WITH 70470 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT AND WITH
CT HEAD OR BRAIN WITHOUT AND WITH CONTRAST Computerized Tomography Advanced
Procedure Code Description Exam Category Copay 321 ANGIOCARDIOGRAPHY Angiography/Interventional Advanced 323 ARTERIOGRAPHY Angiography/Interventional Advanced 0144T CT heart wo dye; qual calc Computerized
HEALTHFIRST 2011 RADIOLOGY PROGRAM CODE LIST
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Anthem Blue Cross and Blue Shield Virginia Advanced Imaging Procedures Requiring Precertification Revised 02/13/2013
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Arteriovenostomy for renal dialysis 39.27, 39.42
Surgery categories NHSN Surgery codes (Reference: NHSN Operative Procedure Category Mappings to ICD-9-CM Codes, October 2010 www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf) Operative aortic aneurysm
RADIOLOGY - X-RAY - COMPUTERIZED AXIAL TOMMOGRAPHY - MAGNETIC RESONENCE IMAGING For the Time Period : 10/01/16 and 09/30/2017
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Description MRI, TMJ C T Head Without Contrast C T Head With Contrast C T Head Without & With Contrast
s Requiring Prior Authorization for the Advanced Imaging 70336 MRI, TMJ 70450 C T Head Without Contrast 70460 C T Head With Contrast 70470 C T Head Without & With Contrast 70480 C T Orbit Without Contrast
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Stroke / CVA TIA Trauma Dizziness Headaches. Acoustic Neuroma Syrinx Visual Change Vascular Lesions (AVM) Elevated Prolactin Vertigo Bell s palsy
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73725x2 MRA Pelvis Runoff (to ankle) CTA Abdomen with & without CTA Cardiac Brain without 70551
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