Read PriorAuthorizationCodesforHigh-techRadiologyServices.pdf text version

March 13, 2012

CPT Code ­ Radiology 0042T 74263

Description Cerebral perfusion analysis using CT with contrast Computed tomographic (CT) colonography, screening, including image postprocessing Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed CT Heart, including quantitative evaluation of coronary calcium CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image post processing, assessment of cardiac function, and evaluation of venous structures, if performed) CT, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image post processing, assessment of cardiac LV function, RV structure and function and evaluation of venous structures, if performed)

Process Requires authorization Requires authorization

74261

Requires authorization

74262

Requires authorization

75571 75572

Requires authorization Requires authorization

75574

Requires authorization

75574

Requires authorization

75574

Requires authorization

75574

Requires authorization

75573

Requires authorization

0159T 70336 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496

70498

70540 70542 70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 70554

70555

71250 71260 71270

CAD, including computer algorithm analysis, BREAST MRI MRI Temporomandibular Joint (s) CT Head without contrast CT Head with contrast CT Head with & without contrast W & W/O CT Orbit, sella, or posterior fossa or outer, middle, or inner ear without contrast CT Orbit, sella, or posterior fossa or outer, middle, or inner ear with contrast CT Orbit, sella, or posterior fossa or outer, middle, or inner ear W & W/O CT Maxillofacial area, (sinus) without contrast CT Maxillofacial area, (sinus) with contrast CT Maxillofacial area, (sinus) with & without contrast W & W/O CT Soft-tissue Neck without contrast CT Soft-tissue Neck with contrast CT Soft-tissue Neck with & without contrast W & W/O CTA HEAD, with contrast, including noncontrast images, if performed, & image post-processing CTA NECK, with contrast, including noncontrast images, if performed, & image post-processing MRI Orbit, Face and/or Neck without contrast MRI Orbit, Face and/or Neck with contrast MRI Orbit, Face and/or Neck with and without contrast W & W/O MR Angiography (MRA) Head without contrast MR Angiography (MRA) Head with contrast MR Angiography (MRA) Head with and without contrast W & W/O MR Angiography (MRA) Neck without contrast MR Angiography (MRA) Neck with contrast MR Angiography (MRA) Neck with and without contrast W & W/O MRI Brain (Head) without contrast MRI Brain (Head) with contrast MRI Brain (Head) with and without contrast W & W/O MRI Brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration MRI, Brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing CT Chest without contrast CT Chest with contrast CT Chest with and without contrast W &

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization

Requires authorization Requires authorization Requires authorization

71275

71550 71551 71552 71555 72125 72126 72127 72128 72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72157 72158 72159 72191

72192 72193 72194 72195 72196 72197 72198 73200 73201 73202 73206

73218 73219

W/O CTA CHEST, (non-coronary), with contrast, including noncontrast images, if performed, & image post-processing MRI Chest without contrast MRI Chest with contrast MRI Chest with and without contrast W & W/O MR Angiography (MRA) Chest (excluding myocardium)- W or W/O CT Cervical Spine without contrast CT Cervical Spine with contrast CT Cervical Spine with and with out contrast W & W/O CT Thoracic Spine without contrast CT Thoracic Spine with contrast CT Thoracic Spine with and without contrast W & W/O CT Lumbar Spine without contrast CT Lumbar Spine with contrast CT Lumbar Spine with and without out contrast W & W/O MRI Cervical Spine without contrast MRI Cervical Spine with contrast MRI Thoracic Spine without contrast MRI Thoracic Spine with contrast MRI Lumbar Spine without contrast MRI Lumbar Spine with contrast MRI Cervical Spine with and without contrast W & W/O MRI Thoracic Spine with and without contrast W & W/O MRI Lumbar Spine with and without contrast W & W/O MR Angiography (MRA) Spinal Canal and contents -with or w/o contrast CTA PELVIS, with contrast, including noncontrast images, if performed, & image post-processing CT Pelvis without contrast CT Pelvis with contrast CT Pelvis with and without contrast W & W/O MRI Pelvis without contrast MRI Pelvis with contrast MRI Pelvis with and without contrast W & W/O MR Angiography (MRA) Pelvis -with or without contrast CT Upper Extremity without contrast CT Upper Extremity with contrast CT Upper Extremity with and without contrast W & W/O CTA Upper Extremity, with contrast, including noncontrast images, if performed, & image postprocessing MRI Upper Extremity-other than jointwithout contrast MRI Upper Extremity-other than joint-with

Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization Requires authorization

73220 73221 73222 73223 73225 73700 73701 73702 73706

73718 73719 73720 73721 73722 73723 73725 74150 74160 74170 74175

74181 74182 74183 74185 75557 75565

75559

75561

75563

contrast MRI Upper Extremity-other than joint-with and without contrast W & W/O MRI Any Joint of Upper Extremity--without contrast MRI Any Joint of Upper Extremity--with contrast MRI Any Joint of Upper Extremity--with and without contrast W & W/O MR Angiography (MRA) Upper Extremity with or without contrast CT Lower Extremity without contrast CT Lower Extremity with contrast CT Lower Extremity with and without contrast W & W/O CTA Lower Extremity, with contrast, including noncontrast images, if performed, & image postprocessing MRI Lower Extremity-other than jointwithout contrast MRI Lower Extremity-other than joint-with contrast MRI Lower Extremity-other than joint-with and without contrast W & W/O MRI Any Joint of Lower Extremity--without contrast MRI Any Joint of Lower Extremity--with contrast MRI Any Joint of Lower Extremity--with and without contrast W & W/O MR Angiography (MRA) Lower Extremitywith or without contrast CT Abdomen without contrast CT Abdomen with contrast CT Abdomen with and without contrast W & W/O CTA ABDOMEN, with contrast, including noncontrast images, if performed, & image postprocessing MRI Abdomen without contrast MRI Abdomen with contrast MRI Abdomen with and without contrast W & W/O MR Angiography (MRA) Abdomen-with or without contrast Cardiac MRI for morphology and function without contrast material Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) Cardiac MRI for morphology and function without contrast material; with stress imaging Cardiac MRI for morphology and function without contrast, followed by contrast W & W/O Cardiac MRI for morphology and function without contrast, followed by contrast; with stress imaging

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization

Requires authorization

Requires authorization

75635

76376

76377

76380 76390 76497 76498 77058 77059 77078 77079 77084 78459 78491 78492 78608 78609 78811 78812 78813 78814

78815

78816

G0219 G0235 S8035 S8037 S8042 S8092

CTA ABDOMINAL AORTA and bilateral iliofemoral lower extremity runoff, with contrast, including noncontrast images, if performed, and image post-processing 3D Rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation 3D Rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation CT Limited or Localized follow-up MR Spectroscopy (MRS) Unlisted CT Procedure (diagnostic, interventional) Unlisted MR MRI BREAST, without and/or with contrast UNILATERAL MRI BREAST, without and/or with contrast BILATERAL CT BONE MINERAL DENSITY study, 1 or more sites, axial skeleton CT BONE MINERAL DENSITY study, 1 or more sites, appendicular MRI Bone Marrow blood supply PET Cardiac (myocardial imaging) ­ metabolic evaluation PET Cardiac (myocardial imaging), perfusion single study at rest or Stress PET Cardiac (myocardial imaging), perfusion multiple studies rest/stress PET Brain ­ metabolic evaluation PET Brain ­ perfusion evaluation PET imaging; limited area (eg, chest, head/neck) PET imaging; skull base to mid-thigh 13 PET imaging; whole body PET imaging with concurrently acquired CT for attenuation correction and anatomical localization; limited area (eg, chest, head/neck) PET imaging with concurrently acquired CT for attenuation correction and anatomical localization; skull base to midthigh PET imaging with concurrently acquired CT for attenuation correction and anatomical localization; whole body PET imaging whole body; melanoma for non-covered indications PET imaging, any site, not otherwise specified Magnetic Source Imaging MRCP (Magnetic Resonance Cholangiopancreatography) MRI Low Field CT ELECTRON BEAM (Ultrafast CT) for

Requires authorization

Requires authorization

Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

Requires authorization

Requires authorization

Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization Requires authorization

74176 74178

74177

calcium scoring Computed tomography; abdomen and pelvis; without contrast material Computed tomography; abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions Computed tomography; abdomen and pelvis; with contrast material(s)

Requires authorization Requires authorization

Requires authorization

Information

6 pages

Find more like this

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

521031


You might also be interested in

BETA
jcp061123952407.pdf
Authorization Requirements by Code.xls
Microsoft Word - CPT Changes_MD Communication_2008.doc