Policy Updates Prior AuthorizationMedicare AdvantageMay 24, 2023

Carelon Medical Benefits Management, Inc. advanced imaging — Imaging of the brain CPT code list update

Effective for dates of service on and after December 1, 2023, the following codes will require prior authorization through Carelon Medical Benefits Management, Inc.* (formerly AIM Specialty Health®).

CPT® code

Description

0042T

Cerebral Perfusion Analysis Using Computed Tomography with Contrast Administration, Including Post-Processing of Parametric Maps with Determination of Cerebral Blood Flow, Cerebral Blood Volume, and Mean Transit Time

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon in one of several ways:

  • Access Carelon’s ProviderPortalSM directly at www.providerportal.com:
    • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
  • Access Carelon via the Availity Essentials* website at www.availity.com.

Note: This update does not apply to the Federal Employee Program®.

If you have any questions related to guidelines, please contact Carelon via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

COBCBS-CR-025221-23-CPN25171

PUBLICATIONS: September 2023 Provider Newsletter