Prior authorization is required for the following outpatient radiology procedures through NIA:
- CT SCAN
- NUCLEAR EXERCISE - TOLERANCE TEST (ETT)
- PET SCAN
Radiology policies 2018 Coding Matrix - NIA (pdf)
Radiology policies 2019 Coding Matrix - NIA (pdf)
Prevea360 Health Plan Provider FAQ (pdf)
It is the responsibility of the ordering physician or clinic to obtain authorization. Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim. Imaging procedures performed during an emergency room and/or urgent care visit or in observation and inpatient facilities do not require authorization.