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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
(Honeywell & Merck)
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
(Pfizer & Allergan)
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
(Honeywell & Merck)
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 15, 2019, and may be subject to change.

CPT® is a registered trademark of the American Medical Association.