Cardiology & Radiology Imaging Procedure Codes
The procedure codes listed within the categories below are subject to Prior Authorization/Medical Necessity Determination review as part of our Cardiology Imaging Program and our Radiology/Imaging Program. This listing was last revised on December 19, 2022 and may be subject to change.
Recent Changes:
-
For services to be provided on and after January 18, 2023, eviCore will also perform PA/MND of the services represented by procedure code 0742T.
-
For services to be provided on and after January 6, 2022, eviCore will also perform MND of the services represented by procedure codes 0697T, 0698T, 0710T, 0711T, 0712T, 0713T and 93319.
Notes:
- The services represented by procedure codes 0710T, 0711T, 0712T, and 0713T are experimental & investigational.
- Coding Note: C-Codes are for facility/hospital use only (only for UB04 claims submission).
Cardiac Codes
- 93452
- 93453
- 93454
- 93455
- 93456
- 93457
- 93458
- 93459
- 93460
- 93461
Cardiac MRI Codes
- 75557
- 75559
- 75561
- 75563
- C9762
- C9763
Cardiac CT Codes
- 0501T
- 0502T
- 0503T
- 0504T
- 75571
- 75572
- 75573
- 75574
CT Codes
- 0633T
- 0634T
- 0635T
- 0636T
- 0637T
- 0638T
- 0742T
- 70450
- 70460
- 70470
- 70480
- 70481
- 70482
- 70486
- 70487
- 70488
- 70490
- 70491
- 70492
- 71250
- 71260
- 71270
- 71271
- 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
- 76376
- 76377
- 76380
- G0297
- S8092
CTA Codes
- 70496
- 70498
- 71275
- 72191
- 73206
- 73706
- 74174
- 74175
- 75635
Echocardiograms Codes
- 93303
- 93304
- 93306
- 93307
- 93308
- 93350
- 93351
- 93319
- C8922
- C8923
- C8924
- C8928
- C8929
- C8930
MRA Codes
- 70544
- 70545
- 70546
- 70547
- 70548
- 70549
- 71555
- 72159
- 72198
- 73225
- 73725
- 74185
- C8900
- C8901
- C8902
- C8909
- C8910
- C8911
- C8912
- C8913
- C8914
- C8918
- C8919
- C8920
- C8931
- C8932
- C8933
- C8934
- C8935
- C8936
MRI Codes
- 0609T
- 0610T
- 0611T
- 0612T
- 0623T
- 0624T
- 0625T
- 0626T
- 0648T
- 0649T
- 0697T
- 0698T
- 0710T
- 0711T
- 0712T
- 0713T
- 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
- 74713
- 76390
- 76391
- 77021
- 77022
- 77046
- 77047
- 77048
- 77049
- 77084
- C8903
- C8905
- C8906
- C8908
- S8037
- S8042
Nuclear Cardiac Imaging Codes
- 78414
- 78428
- 78445
- 78451
- 78452
- 78453
- 78454
- 78456
- 78457
- 78458
- 78466
- 78468
- 78469
- 78472
- 78473
- 78481
- 78483
- 78494
- 78496
Nuclear Medicine Codes
- 78012
- 78013
- 78014
- 78015
- 78016
- 78018
- 78020
- 78070
- 78071
- 78072
- 78075
- 78102
- 78103
- 78104
- 78185
- 78195
- 78201
- 78202
- 78215
- 78216
- 78226
- 78227
- 78230
- 78231
- 78232
- 78258
- 78261
- 78262
- 78264
- 78265
- 78266
- 78278
- 78282
- 78290
- 78291
- 78300
- 78305
- 78306
- 78315
- 78579
- 78580
- 78582
- 78597
- 78598
- 78600
- 78601
- 78605
- 78606
- 78610
- 78630
- 78635
- 78645
- 78650
- 78660
- 78700
- 78701
- 78707
- 78708
- 78709
- 78725
- 78730
- 78740
- 78761
- 78800
- 78801
- 78802
- 78803
- 78804
- 78830
- 78831
- 78832
- S8080
PET Scans Codes
- 78429
- 78430
- 78431
- 78432
- 78433
- 78434
- 78459
- 78491
- 78492
- 78608
- 78609
- 78811
- 78812
- 78813
- 78814
- 78815
- 78816
- G0219
- G0235
- G0252
- S8085
Unlisted Codes
- 76497
- 76498
- 76499
- 78099
- 78199
- 78299
- 78399
- 78499
- 78599
- 78799
- 78999
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