Anthem Blue Cross and Blue Shield | CommercialJuly 1, 2022
Radiology prior authorization review transitioned to AIM; prior authorization required
This is a courtesy reminder that diagnostic imaging services requested on or after November 1, 2021, for Anthem Blue Cross and Blue Shield (Anthem) members enrolled in the Federal Employee Program® (FEP) transitioned to AIM Specialty Health® (AIM).* These services require prior authorization to determine medical necessity prior to rendering the service for Anthem members enrolled in FEP.
Please contact AIM prior to rendering the service to obtain pre-service review for the following non-emergency modalities. Attached is the list of procedure code and description of the services that require prior authorization.
Procedure codes (PX codes) for radiology/cardiology diagnostic imaging services:
|
CPT®/ HCPCS |
AMA medium description |
|
74150 |
CT ABDOMEN W/O CONTRAST MATERIAL |
|
74160 |
CT ABDOMEN W/CONTRAST MATERIAL |
|
74170 |
CT ABDOMEN W/O & W/CONTRAST MATERIAL |
|
72192 |
CT PELVIS W/O CONTRAST MATERIAL |
|
72193 |
CT PELVIS W/CONTRAST MATERIAL |
|
72194 |
CT PELVIS W/O & W/CONTRAST MATERIAL |
|
72125 |
CT CERVICAL SPINE W/O CONTRAST MATERIAL |
|
72126 |
CT CERVICAL SPINE W/CONTRAST MATERIAL |
|
72127 |
CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL |
|
72128 |
CT THORACIC SPINE W/O CONTRAST MATERIAL |
|
72129 |
CT THORACIC SPINE W/CONTRAST MATERIAL |
|
72130 |
CT THORACIC SPINE W/O & W/CONTRAST MATERIAL |
|
72131 |
CT LUMBAR SPINE W/O CONTRAST MATERIAL |
|
72132 |
CT LUMBAR SPINE W/CONTRAST MATERIAL |
|
72133 |
CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL |
|
73200 |
CT UPPER EXTREMITY W/O CONTRAST MATERIAL |
|
73201 |
CT UPPER EXTREMITY W/CONTRAST MATERIAL |
|
73202 |
CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL |
|
73700 |
CT LOWER EXTREMITY W/O CONTRAST MATERIAL |
|
73701 |
CT LOWER EXTREMITY W/CONTRAST MATERIAL |
|
CPT/ HCPCS |
AMA medium description |
|
73702 |
CT LOWER EXTREMITY W/O & W/CONTRAST MATRL |
|
70551 |
MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL |
|
70552 |
MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL |
|
70553 |
MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL |
|
73218 |
MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL |
|
73219 |
MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL |
|
73220 |
MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS |
|
72141 |
MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL |
|
72142 |
MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL |
|
72156 |
MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL |
|
72146 |
MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL |
|
72147 |
MRI SPINAL CANAL THORACIC W/CONTRAST MATRL |
|
72157 |
MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL |
|
72148 |
MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL |
|
72149 |
MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL |
|
72158 |
MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL |
|
75557 |
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST |
|
75559 |
CARDIAC MRI W/O CONTRAST W/STRESS IMAGING |
|
75561 |
CARDIAC MRI W/WO CONTRAST & FURTHER SEQ |
|
75563 |
CARDIAC MRI W/W/O CONTRAST W/STRESS |
|
78451 |
MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS |
|
78452 |
MYOCARDIAL SPECT MULTIPLE STUDIES |
|
78453 |
MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS |
|
78454 |
MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES |
|
70540 |
MRI ORBIT FACE &/NECK W/O CONTRAST |
|
70542 |
MRI ORBIT FACE & NECK W/CONTRAST MATERIAL |
|
70543 |
MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL |
|
70336 |
MRI TEMPOROMANDIBULAR JOINT |
|
71550 |
MRI CHEST W/O CONTRAST MATERIAL |
|
71551 |
MRI CHEST W/CONTRAST MATERIAL |
|
71552 |
MRI CHEST W/O & W/CONTRAST MATERIAL |
|
74181 |
MRI ABDOMEN W/O CONTRAST MATERIAL |
|
74182 |
MRI ABDOMEN W/CONTRAST MATERIAL |
|
74183 |
MRI ABDOMEN W/O & W/CONTRAST MATERIAL |
|
72195 |
MRI PELVIS W/O CONTRAST MATERIAL |
|
72196 |
MRI PELVIS W/CONTRAST MATERIAL |
|
72197 |
MRI PELVIS W/O & W/CONTRAST MATERIAL |
|
77046 |
MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL |
|
77048 |
MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL |
|
77047 |
MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL |
|
77049 |
MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL |
|
77084 |
BONE MARROW BLOOD SUPPLY |
|
70544 |
MRA HEAD W/O CONTRST MATERIAL |
|
70545 |
MRA HEAD W/CONTRAST MATERIAL |
|
70546 |
MRA HEAD W/O & W/CONTRAST MATERIAL |
|
71555 |
MRA CHEST W/O & W/CONTRAST MATERIAL |
|
74185 |
MRA ABDOMEN W/WO CONTRAST MATERIAL |
|
72198 |
MRA PELVIS W/WO CONTRAST MATERIAL |
|
73225 |
MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL |
|
73725 |
MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL |
|
72159 |
MRA SPINAL CANAL W/WO CONTRAST MATERIAL |
|
77078 |
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE |
|
78608 |
BRAIN IMAGING PET METABOLIC EVALUATION |
|
78609 |
BRAIN IMAGING PET PERFUSION EVALUATION |
|
78466 |
MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN |
|
78468 |
MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ |
|
78469 |
MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ |
|
73718 |
MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL |
|
73719 |
MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL |
|
73720 |
MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR |
|
73721 |
MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL |
|
73722 |
MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL |
|
73723 |
MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL |
|
73221 |
MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL |
|
73222 |
MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL |
|
73223 |
MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL |
|
78459 |
MYOCRD IMG PET METAB EVAL SINGLE STUDY |
|
78491 |
MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS |
|
78492 |
MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS |
|
78429 |
MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT |
|
78430 |
MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT |
|
78431 |
MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT |
|
78432 |
MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER |
|
78433 |
MYOCARD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT |
|
70496 |
CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST |
|
70498 |
CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST |
|
CPT/ HCPCS |
AMA medium description |
|
70547 |
MRA NECK W/O CONTRST MATERIAL |
|
70548 |
MRA NECK W/CONTRAST MATERIAL |
|
70549 |
MRA NECK W/O &W/CONTRAST MATERIAL |
|
71275 |
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST |
|
72191 |
CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST |
|
73206 |
CT ANGIOGRAPHY UPPER EXTREMITY |
|
73706 |
CT ANGIOGRAPHY LOWER EXTREMITY |
|
74175 |
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST |
|
76390 |
MRI SPECTROSCOPY |
|
78472 |
CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS |
|
78473 |
CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT |
|
78481 |
CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT |
|
78483 |
CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT |
|
78494 |
CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT |
|
78811 |
PET IMAGING LIMITED AREA CHEST HEAD/NECK |
|
78812 |
PET IMAGING SKULL BASE TO MID-THIGH |
|
78813 |
PET IMAGING WHOLE BODY |
|
78814 |
PET IMAGING CT FOR ATTENUATION LIMITED AREA |
|
78815 |
PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH |
|
78816 |
PET IMAGING FOR CT ATTENUATION WHOLE BODY |
|
74263 |
CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING |
|
74261 |
CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST |
|
74262 |
CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST |
|
70554 |
MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION |
|
70555 |
MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION |
|
75571 |
CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM |
|
75572 |
CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH |
|
75573 |
CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D |
|
75574 |
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST |
|
74176 |
CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL |
|
74177 |
CT ABDOMEN & PELVIS W/CONTRAST MATERIAL |
|
74178 |
CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE |
|
74712 |
FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES |
|
74174 |
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG |
|
75635 |
CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP |
|
71271 |
COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- |
|
76391 |
MAGNETIC RESONANCE ELASTOGRAPHY |
|
93350 |
ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST |
|
93351 |
ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG |
|
93303 |
COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY |
|
93304 |
F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY |
|
93306 |
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D |
|
93307 |
ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP |
|
93308 |
ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD |
|
93312 |
ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R |
|
93313 |
ECHO R-T 2D W/PROBE PLACEMENT ONLY |
|
93314 |
ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY |
|
93315 |
ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R |
|
93316 |
ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY |
|
93317 |
ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT |
How to submit a request for review
As a reminder, providers can submit requests for review or can verify order numbers using one of the following methods as a registered AIM portal provider:
|
How to register online:
|
The AIM ProviderPortalSM is available 24/7, fully interactive, and processes requests in real‑time using Clinical Criteria. To register, go to:
https://aimspecialtyhealth.com/providerportal.
|
|
How to register by phone: |
Call AIM Specialty Health toll-free at 866-789-0397, Monday through Friday between 7 a.m. to 7 p.m. CT. |
|
For more information about the Radiology Program and to help your practice get started: |
Go to http://www.aimprovider.com/radiology.
|
Anthem values your participation in our network as well as the services you provide. We look forward to working with you to help improve the health of our members.
PUBLICATIONS: July 2022 Anthem Provider News - Virginia
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