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Radiology/Imaging Services Program Documentation Updated for 2018

The following Cardiac CT codes, recently introduced by the American Medical Association (AMA), will require Prior Authorization/Medical Necessity Determination (PA/MND) as part of the Cardiology and Advanced Imaging programs:

  • 0501T
  • 0502T
  • 0503T
  • 0504T

This is effective for services rendered on and after March1, 2018. Please review the updated list of Radiology Codes Requiring Prior Authorization.

The guidelines included in the following updated program documentation will also be implemented for services provided on and after March1, 2018.

Horizon Blue Cross Blue Shield of New Jersey collaborates with eviCore healthcare to help ensure appropriateness in care and quality standards by managing our Radiology, Cardiology, Musculoskeletal, Radiation Therapy and Molecular Service programs.

Through our Cardiology and Advanced Imaging programs, eviCore healthcare helps to ensure that our members receive appropriate radiology/imaging services, including CT/CTA, MRI/MRA, PET, nuclear medicine studies and nuclear cardiology through PA/MND. eviCore healthcare also assists Horizon BCBSNJ members in the scheduling of Advanced Imaging Services.

For more information about this and other eviCore programs, visit HorizonBlue.com/evicore.

If you have questions, call Physician Services at 1-800-624-1110 or Institutional Services at 1-888-666-2535.

Published on: January 30, 2018, 16:25 p.m. ET
Last updated on: April 18, 2018, 06:49 a.m. ET