Radiology prior authorization

providers looking at CT scans

Alert: Effective for service dates on and after 9/1/2020, the health plan is reinstating the prior authorization requirement for Chest CT scans, which was temporarily waived in response to the COVID-19 public health emergency.

Required for outpatient procedures

Prior authorization is required for the following outpatient radiology procedures 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. If you fail to do so, it could result in non-payment of your claim.
 
Imaging procedures performed during an emergency room and/or urgent care visit or in observation and inpatient facilities do not require authorization.
 

Additional resources