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2007 UnitedHealthcare Radiology Accreditation Table

The chart below contains the CPT codes that are included for the UnitedHealthcare Radiology Accreditation Program. Please note: Effective March 1, 2008, UnitedHealthcare will require freestanding facilities and physician offices that use a CMS 1500 Claim form to obtain accreditation as a condition for reimbursement for specific outpatient imaging studies. The imaging studies include CT, CTA, MRI, MRA, PET, Nuclear Medicine, Nuclear Cardiology, and Echocardiography.

CPT Code

70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 71250 71260 71270 71275

Description

CT/CTA Computed tomography, head or brain; without contrast material CT Head/brain w/ contrast CT Head/brain w/o & w/ contrast Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material CT orbit w/ contrast CT orbit w/o & w/ contrast Computed tomography, maxillofacial area; without contrast material CT Maxllfcl w/ contrast CT Maxllfcl w/o & w/ contrast Computed tomography, soft tissue neck; without contrast material CT Soft tissue neck w/ contrast CT Soft tissue neck w/o & w/ contrast CT Angiography, head CT Angiography, neck Computed tomography, thorax; without contrast material CT Thorax w/ contrast CT Thorax w/o & w/ contrast Computed tomographic angiography, chest without contrast material(s), followed by contrast material(s) and further sections, including image postprocessing Computed tomography, cervical spine; without contrast material CT C Spine w/ contrast CT C Spine w/o & w/ contrast Computed tomography, thoracic spine; without contrast material CT T Spine w/ contrast CT T Spine w/o & w/ contrast Computed tomography, lumbar spine; without contrast material CT L Spine w/ contrast CT L Spine w/o & w/ contrast CT Angiography pelvis Computed tomography, pelvis; without contrast material CT Pelvis w/ contrast CT Pelvis w/o & w/ contrast Radiological Supervision and Interpretation, Percutaneious Vertebroplasty or Vertebral Augmentation Including cavity creation under CT Guidance Computed tomography, upper extremity; without contrast material CT Upper extremity w/ contrast CT Upper extremity w/o & w/ contrast CT Angiography upper extremity Computed tomography, lower extremity; without contrast material

73701 73702 73706 74150 74160 74170 74175 75635 76070 76365 76380 76497 77084 0144T

0145T

0146T

0147T

72125 72126 72127 72128 72129 72130 72131 72132 72133 72191 72192 72193 72194 72292

0148T

0149T

0150T 0151T

CT/CTA (continued) CT Lower extremity w/ contrast CT Lower extremity w/o & w/ contrast CT Angiography lower extremity Computed tomography, abdomen; without contrast material CT Abdomen w/ contrast CT Abdomen w/o & w/ contrast CT Angiography abdomen CT Angiography abdominal aorta CT Bone Mineral Density Study 1/>Stie;Appendicular Skel CT Guidance Cyst Aspiration Superior/Interior CT Limited or localized follow-up study Unlisted CT Procedure MRI Imaging Bone Marrow Blood Supply Computed tomography, heart, without contrast material, including image post processing and quantitative evaluation of coronary calcium Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology Computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium Computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium Cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium Cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium Cardiac structure and morphology in congenital heart disease CT Angio without contrast material followed by contrast material MRI/MRA MR Imaging Temporomandibular Joint MRI Face, orbit, neck w/o contrast Magn Resonance Angio, Head and/or Neck, W or WO Contrast MRI Face, orbit, neck with contrast MRI Face, orbit, neck w/ & w/o contrast MRA Head w/o contrast MRA Head w/ contrast MRA Head w/ & w/o contrast MRA Neck w/o contrast MRA Neck w/ contrast MRA Neck w/ & w/o contrast

70336 70540 70541 70542 70543 70544 70545 70546 70547 70548 70549

73200 73201 73202 73206 73700

70551 70552 70553 70554 70555 70557 70558 70559 71550 71551 71552 71555 72141 72142 72146 72147 72148 72149 72156 72157 72158 72159 72195 72196 72197 72198 73218 73219 73220 73221 73222 73223 73225 73718 73719 73720 73721 73722 73723 73725 74181 74182 74183 74185 75552 75553 75554 75555 75556 76390 76498 77021 77022

MRI/MRA (continued) MRI Head w/o contrast MRI Head w/ contrast MRI Head w/ & w/o contrast MRI Orbit, Face and/or Neck w/o contrast MRI Brain: Requiring MD administration of entire neurofunctional testing MRI Brain During Open Intracran Proc; W/O Contrast 2004 MRI Brain During Open Intracran Proc; W/Contrast MRI Brain During Intrancran; No Contrast FLWed Con2004 MRI Chest w/o contrast MRI Chest w contrast MRI Chest w & w/o contrast MRA Chest (exc myocardium) w/ or w/o contrast MRI Cervical spine w/o contrast MRI Cervical spine w/ contrast MRI Thoracic spine w/o contrast MRI Thoracic spine w/ contrast MRI Lumbar spine w/o contrast MRI Lumbar spine w/ contrast MRI C Spine w/ & w/o contrast MRI T Spine w/ & w/o contrast MRI L Spine w/ & w/o contrast MRA Spinal canal w/or w/o contrast MRI Pelvis w/o contrast MRI Pelvis w/ contrast MRI Pelvis w/ & w/o contrast MRA Pelvis w or w/o contrast MRI Upper extremity other than joint w/o contrast MRI Upper extremity other than joint w contrast MRI Upper extremity other than joint w/ & w/o contrast MRI Upper extremity joint w/o contrast MRI Upper extremity joint w/ contrast MRI Upper extremity joint w/ & w/o contrast MRI Upper extremity, with or w/o contrast MRI Lower extremity other than joint w/o contrast MRI Lower extremity joint w/ contrast MRI Lower extremity other than joint w/ & w/o contrast MRI Lower extremity joint w/o contrast MRI Lower extremity joint w/ contrast MRI Lower extremity joint w/ & w/o contrast MRA Lower extremity w/ or w/o contrast MRI Abdomen w/o contrast MRI Abdomen w/ contrast MRI Abdomen w/ & w/o contrast MRA Abdomen w/ or w/o contrast Cardiac MRI for morphology w/o contrast (gated heart) Cardiac MRI morphology w/ contrast Cardiac MRI COMPLETE w/ or w/o morphology Cardiac MRI limited Cardiac MRI for velocity flow mapping MRI Spectroscopy Unlisted MRI Procedure MRI Guidance for needle placement; Rad supervision & interpretation MRI Guidance for monitoring of parenchymal tissue ablation

77058 77059 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 78099 78102 78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78160 78162 78170 78172 78185 78190 78191 78195 78199 78201 78202 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78267 78270 78271 78272 78278

MRI/MRA (continued) MRI Breast w/and/or w/o contrast unilateral MRI Breast w/and/or w/o contrast Bilateral Nuclear Medicine/Cardiology Thyroid rai uptake Thyroid, multiple uptakes Thyroid suppress or stimulation Thyroid uptake and scan Thyroid, image, multiple uptakes Thyroid scan only Thyroid imaging with flow Thyroid met imaging Thyroid met imaging with additional studies Thyroid scan whole body Thyroid carcinoma metastases uptake Parathyroid nuclear imaging Adrenal nuclear imaging Unlisted endocrine procedure, diagnostic nuclear medicine Bone marrow imaging, limited Bone marrow imaging, multiple Bone marrow imaging, whole body Plasma volume, single Plasma volume, multiple sampling Red cell volume determination, single sampling Red cell volume determination, multiple sampling Whole blood volume determination, sep plasma & red cell Red cell survival study Differential organ / tissues kinetic Labeled red cell sequestration Plasma Radioiron Disappearance Rate Radioiron Oral Absorption Radioiron Red Cell Utilization Chelatable Iron Estimation Total Body Spleen imaging w & w/o vascular flow Platelet survival, kinetics Platelet survival Lymph system imaging Unlisted hematopoietic diagnostic nuclear medicine Liver imaging Liver imaging with flow Liver imaging spect w/ vascular flow Liver & spleen imaging Liver & spleen imaging with flow Liver function study HIDA Scan Salivary gland imaging Serial salivary gland Salivary gland function exam Esophagus motility study Gastric mucosa imaging Gastroesophageal reflux exam Gastric emptying study Urea Breath Test, C-14 (isotopic); acquisition for analysis VIT-B12 Absorption exam VIT-B12 Absorption exam, lf VIT-B12 Absorption exam combined GI Bleeder scan

78282 78290 78291 78299 78300 78305 78306 78315 78350 78351 78399 78414 78428 78445 78456 78457 78458 78460 78461 78466 78468 78472 78473 78478 78480 78481 78483 78494 78496 78499 78580 78584 78585 78586 78587 78588 78591 78593 78594 78596 78599 78600 78601 78605 78606 78610 78615 78630 78635 78645 78650 78660 78699 78700 78701 78704 78707

Nuclear Medicine/Cardiology (continued) GI Protein exam Meckel's diverticulum imaging Leveen shunt patency exam Unlisted gastrointestinal procedure Bone or joint imaging ltd Bone or joint imaging multiple Bone scan whole body Bone scan 3 phase study Bone Density-1/>Sites; Single Photon Bone Density-1/>Sites; Dual Photon Unlisted musculoskeletal procedure Non-imaging heart function Cardiac shunt imaging Radionuclide venogram non-cardiac Acute venous thrombosis imaging, peptide Venous thrombosis imaging unilateral Venous thrombosis images, bilateral Thallium scan rest only Myocardial perf stress or rest multiple study Myocardial infarction scan Heart infarct image EF Gated heart, resting Cardiac blood pool muga scan Myocardial wall motion study Myocardial ejection fraction Heart first pass single Cardiac blood pool imaging-multiple Cardiac blood pool imaging, spect Cardiac Blood Pool Imaging - Single study @ rest (Use with 78472) Unlisted cardiovascular nuclear exam Pulmonary perfusion imaging Pulmonary perfusion with vent single breath Pulmonary perfusion w/ washout, w or w/o single breath Pulmonary ventilation imaging Pulmonary ventilation multi Pulmonary perfusion w/ ventilation Vent image 1 breath, 1 projection Vent image 1 projection, gas Vent image multi projection, gas Lung differential function Unlisted respiratory nuclear exam Brain imaging LTD Static Brain LTD imaging and flow Brain imaging complete Brain imaging complete with flow Brain flow imaging only Cerebral blood flow imaging Cisternogram (cerebrospinal fluid flow) Cerebrospinal ventriculography CSF Shunt evaluation CSF Leakage detection and localization Radiopharmaceutical dacryocystography Unlisted diagnostic nuclear med procedure Kidney imaging (static) Kidney imaging w/ vascular flow Kidney imaging w/ function study

Kidney imaging w/vascular flow & function single study

78708 78709 78715 78725 78730 78740 78760 78761 78799 78800 78801 78802 78804 78805 78806 78890 78891 78990 78999 79000 79001 79005 79020 79030 79035 79100 79101 79200 79299 79300 79400 79403 79420 79440 78205 78320 78464 78465 78469 78607 78647 78710 78803

78459 78491 78492 78608

Nuclear Medicine/Cardiology (continued) Kidney imaging single study w/ pharm. intervention Kidney imaging- multiple studies w & w/o pharm. intervention Kidney vascular flow only Kidney function study - non-imaging radioisotopic Urinary bladder residual study Ureteral reflux study Testicular imaging Testicular imaging w/ vascular flow Unlisted genitourinary procedure Radiopharm localization of tumor or distribution of Radiopharm agent(s), limited area Radiopharm localization of tumor, multiple areas Radiopharm localization of tumor, whole body, single day imaging Radiopharm localization of tumor or distribution of Radiopharm agent(s); whole body, requiring two or more days imaging Radiopharm localization of abscess, limited area Radiopharm localization of abscess, whole body Gen Auto Data; Simpl To 30 Min Gen Auto Data; Complex > 30 Min Provision of Diag. Radiopharmaceuticals Unlisted misc. procedure Radiopharm Tx Herper-Thyroid;1st Radiopharm Tx Hyper-Thyroid; SubSQT Radiopharm Therapy Oral Administration Radiopharm TX Throid Suppression Radopharm Ablat Gland Thyroid Cancer Radopharm Therapy Mets Thyroid Cancer Radphm TX Polycythem Vera Chron Leukem E T2004 Radiopharmaceutical Therapy IV Admin Radiopharmaceutical Therapy Intracavitary Admin Unlisted gastrointestinal procedure Radiopharm TX Interstitial Rad Colloid Admin Radopharm TX Nonthyroid Nonhematologic IV Inj2004 Radiophm TX Monoclonal Antibody IV Infusion 2004 Ivasc Radophrm Therapy Particulate Radiopharmaceutical Therapy Intra-Articular Admin Liver imaging spect (3D) Bone joint imaging tomo test Heart image (3-D) single Myocardial perf w/ spect multiple Heart infarct image 3-D Brain imaging 3-D Cerebrospinal fluid scan Kidney imaging - tomographic (spect) Radiopharm localization of tumor tomographic(spect) PET Myocardial imaging, positron emission tomography (pet) metabolic eval. Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest or stress Brain imaging, positron emission tomography (PET) metabolic evaluation

PET (continued) 78609 78807 78811 78812 78813 Brain imaging, positron emission tomography (PET) metabolic evaluation, perfusion evaluation Radiopharm localization of abscess, tomographic spect Tumor imaging, positron emission tomography (PET); limited area (eg, chest, head/neck) Tumor imaging, positron emission tomography (PET); skull base to mid-thigh Tumor imaging, positron emission tomography (PET); whole body Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (eg, chest, head/neck) Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body Interpretation & Reporting 3D Rendering with Interpretation and Reporting of CT,MRI,US, etc. 3D Rendering with Interpretation and Reporting of CT,MRI,US, etc. Echocardiography 93303 93304 93307 Thransthoracic Echocardiography for Congenital Cardiac Anomalies; Complete Transthoracic Echocardiology; Follow-up or Limited Study Echocardiography, Transthoracic, Real-Time w/Image Documentation w/or w/o M-mode recording; complete 93308

Echocardiography Echocardiography, Transthoracic, Real-Time w/Image Documentation w/or w/o M-mode recording; Follow-up or Limited Study Echocardiography, Transesophageal, Real-Time with Image Documentation (2D) w/&w/o M-mode recording; including probe placement, image acquisition, interpretation and report Echocardiography, Transesophageal, Real-Time with Image Documentation (2D) w/&w/o M-mode recording; including probe placement only Image Acquisition, Interpretation and report only Transesophageal Echocardiography for Congenital Cardiac Anomalies; including probe placement, image acquisition, interpretation and report Transesophageal Echocardiography for Congenital Cardiac Anomalies; including probe placement only Image Acquisition, Interpretation and report only Echocardiography, transesophageal for monitoring purposes, including probe placement, real time 2dimensional image acquisition and interpretation leading to continuous assessment of cardiac pumping function and to therapeutic measures on an immediate time bases Doppler Echocardiography, pulsed waved &/or continuous wave with spectral display; complete Doppler Echocardiography, pulsed waved &/or continuous wave with spectral display; Follow-up or Limited Study Doppler Echocardiography color flow velocity mapping Echocardiography, thransthoracic, real-time w/image documentation during rest & cardiovascular stress test using treadmill, bicycle or pharmacologically induced stress, w/interpretation & report.

93312

93313 93314 93315 93316 93317

78814

78815

93318

78816

93320 93321 93325

76376 76377

93350

Last Update: 01/15/2007

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