Procedure Codes Reviewed by AIM
AIM Specialty Health will conduct pre-service medical necessity reviews of the following elective outpatient CT, CTA, MRA, MRI nuclear cardiology, PET scans, echocardiography exams, sleep management, major joint and pain management services to be provided to Horizon BCBSNJ members enrolled in certain National Account self-insured groups.
| Service Categories | Procedure Codes Reviewed by AIM |
| CT | 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 71250, 71260, 71270, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72192, 72193, 72194, 73200, 73201, 73202, 73700, 73701, 73702, 74150, 74160, 74170, 74176, 74177, 74178, 74261, 74262, 74263, 75571, 75572, 75573, 77078, G0297 |
| CTA | 70496, 70498, 71275, 72191, 73206, 73706, 74174, 74174, 74175, 75574, 75635, 75635 |
| MRI | 70336, 70540 70542, 70543, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73718, 73719, 73720, 73721, 73722, 73723, 74181, 74182, 74183, 74712, 75557, 75559, 75561, 75563, 76390, 77058, 77059, 77084 |
| MRA | 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185 |
| Pain Management (Advansix, Catalent, DSM, Honeywell, Merck & Sanofi) |
27096, 62320, 62321, 62322, 62323, 63650, 63655, 63663, 63664, 63685, 63688, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, G0260, 0228T, 0229T, 0230T, 0231T, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64640 |
| Medical Oncology (Advansix, Allergan, Catalent & Pfizer) |
J9354, J9019, J9022, J9023, J9032, J9033, J9034, J9035, J9039, J9042, J9043, J9047, J9055, J9145, J0881, J0882, J0897, J9176, J0885, Q4081, Q5106, J9179, J1442, Q5101, J9203, J1627, Q5110, J1459, J1557, J1566, J1568, J1572, J1599, J1556, J1559, J1569, J1561, J1555, J1575, J9228, J9205, J0641, J9295, J9299, J9301, J9302, J9285, J9262, J9264, J2469, J9303, J9266, J2505, Q5108, J9271, J9305, J9306, J9308, C9467, J2820, J2860, Q2043, J1447, J9352, J9355, J9371, J9400, J9155, J1675, J9225, J1950, J9217, J9218, J9202, J1915, J3315, J9325, J9041, J9310 |
| Nuclear Cardiology | 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494 |
| Major Joint (Advansix, Catalent, DSM, Honeywell, Merck & Sanofi) |
23105, 23107, 23120, 23130, 23410, 23412, 23415, 23420, 23430 ,23440, 23450, 23455, 23460, 23462, 23465, 23466, 27331, 27332, 27333, 27334, 27335, 27403, 27405, 27407, 27409, 27412, 27415, 27416, 27427, 27428, 27429, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29914, 29915, 29916, 23700, J7330, S2112, G0289 |
| PET scans | 78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816 |
| Echocardiography | 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93350, 93351 |
| Sleep Management and Radiology | 95782, 95783, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, 95811, A4604, A7027, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0470, E0471, E0485, E0486, E0561, E0562, E0601, E1399, G0398, G0399, G0400 |
The AIM Specialty Health program is for educational and quality of care purposes and is not a formal prior authorization program.
This information was last revised on January 18, 2021, and may be subject to change.
CPT® is a registered trademark of the American Medical Association.
