Radiology Codes Requiring Authorization*

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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) 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material 70481 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) 70482 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followe 70486 Computed tomography, maxillofacial area; without contrast material 70487 Computed tomography, maxillofacial area; with contrast material(s) 70488 Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further section 70490 Computed tomography, soft tissue neck; without contrast material 70491 Computed tomography, soft tissue neck; with contrast material(s) 70492 Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections 70496 Computed tomographic angiography, head, without contrast material(s), followed by contrast material(s) and further secti 70498 Computed tomographic angiography, neck, without contrast material(s), followed by contrast material(s) and further secti 70540 Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast material(s) 70542 Magnetic resonance (eg, proton) imaging, orbit, face, and neck; with contrast material(s) 70543 Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast material(s), followed by contrast mater 70544 Magnetic resonance angiography, head; without contrast material(s) 70545 Magnetic resonance angiography, head; with contrast material(s) 70546 Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequenc 70547 Magnetic resonance angiography, neck; without contrast material(s) 70548 Magnetic resonance angiography, neck; with contrast material(s) 70549 Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequenc 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material 70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast m 70554 Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part m 70555 Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofun 70557 Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure

70558 Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure 70559 Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure 71250 Computed tomography, thorax; without contrast material 71260 Computed tomography, thorax; with contrast material(s) 71270 Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections 71275 Computed tomographic angiography, chest, without contrast material(s), followed by contrast material(s) and further sect 71550 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without co 71551 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contr 71552 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without co 71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) 72125 Computed tomography, cervical spine; without contrast material 72126 Computed tomography, cervical spine; with contrast material 72127 Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections 72128 Computed tomography, thoracic spine; without contrast material 72129 Computed tomography, thoracic spine; with contrast material 72130 Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections 72131 Computed tomography, lumbar spine; without contrast material 72132 Computed tomography, lumbar spine; with contrast material 72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material 72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material 72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 72149 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) 72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast mate 72157 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast mate 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast mate 72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) 72191 Computed tomographic angiography, pelvis, without contrast material(s), followed by contrast material(s) and further sec

72192 Computed tomography, pelvis; without contrast material 72193 Computed tomography, pelvis; with contrast material(s) 72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) 72196 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and furt 72198 Magnetic resonance angiography, pelvis, with or without contrast material(s) 73200 Computed tomography, upper extremity; without contrast material 73201 Computed tomography, upper extremity; with contrast material(s) 73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections 73206 Computed tomographic angiography, upper extremity, without contrast material(s), followed by contrast material(s) and fu 73218 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) 73219 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) 73220 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by co 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) 73222 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) 73223 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contras 73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s) 73700 Computed tomography, lower extremity; without contrast material 73701 Computed tomography, lower extremity; with contrast material(s) 73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections 73706 Computed tomographic angiography, lower extremity, without contrast material(s), followed by contrast material(s) and fu 73718 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) 73719 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) 73720 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by con 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s) 73722 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contras 73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) 74150 Computed tomography, abdomen; without contrast material

74160 Computed tomography, abdomen; with contrast material(s) 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postpro 74175 Computed tomographic angiography, abdomen, without contrast material(s), followed by contrast material(s) and further se 74176 Computed tomography, abdomen and pelvis; without contrast material 74177 Computed tomography, abdomen and pelvis; with contrast material(s) 74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sec 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) 74182 Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) an 74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) 74261 "Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material" 74262 "Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including 74263 "Computed tomographic (CT) colonography, screening, including image postprocessing" 75557 Cardiac magnetic resonance imaging for morphology and function without contrast material; 75559 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging 75561 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast materi 75563 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast materi 75565 Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) 75571 "Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium" 75572 "Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D im 75573 "Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting o 75574 "Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, in 75635 Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, radiological supervi 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other 76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other 76380 Computed tomography, limited or localized follow-up study 76390 Magnetic resonance spectroscopy 76497 Unlisted computed tomography procedure (eg, diagnostic, interventional) 76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional)

77011 Computed tomography guidance for stereotactic localization 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological 77013 Computerized tomography guidance for, and monitoring of, parenchymal tissue ablation 77014 Computed tomography guidance for placement of radiation therapy fields 77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localiza 77022 Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation 77058 Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral 77059 Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral 77078 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) 77079 Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply 77299 Unlisted procedure, therapeutic radiology clinical treatment planning 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services 77499 Unlisted procedure, therapeutic radiology treatment management 77799 Unlisted procedure, clinical brachytherapy 78451 "Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall m 78452 "Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall m 78453 "Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pas 78454 "Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pas 78452 "Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall m 78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative 78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique 78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification 78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), w 78473 Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and s 78481 Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress (exercise and/or pharma 78483 Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest and with stress (exercise and 78491 Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress 78492 Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress 78494 Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without

78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first 78499 Unlisted cardiovascular procedure, diagnostic nuclear medicine 78607 Brain imaging, complete study; tomographic (SPECT) 78608 Brain imaging, positron emission tomography (PET); metabolic evaluation 78609 Brain imaging, positron emission tomography (PET); perfusion evaluation 78802 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, single day imagin 78804 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, requiring two or 78811 Tumor imaging, positron emission tomography (PET); limited area (eg, chest, head/neck) 78812 Tumor imaging, positron emission tomography (PET); skull base to mid-thigh 78813 Tumor imaging, positron emission tomography (PET); whole body 78814 Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation co 78815 Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation co 78816 Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation co 78999 Unlisted miscellaneous procedure, diagnostic nuclear medicine 79005 Radiopharmaceutical therapy, by oral administration 79101 Radiopharmaceutical therapy, by intravenous administration 79445 Radiopharmaceutical therapy, by intra-arterial particulate administration 79999 Radiopharmaceutical therapy, unlisted procedure S8035 Magnetic source imaging S8037 Magnetic resonance cholangiopancreatography (MRCP) S8042 Magnetic resonance imaging (MRI), low-field S8092 Electron beam computed tomography (also known as Ultrafast CT, Cine CT)