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.


This website can also help you learn more about provider access to useful information and tools such as order entry checklists and clinical guidelines.

 

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.

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc.

 

VABCBS-COMM-002029-22



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July 2022 Anthem Provider News - Virginia