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December 2015

Clarification: Preauthorization for abdomen and pelvis CT scans

It’s come to our attention that some facility providers aren’t sure how to handle preauthorization for abdomen and pelvis CT scans. We’ve clarified the rules below.

The preauthorization process for CT abdomen (*74150, *74160, *74170), CT pelvis (*72192-*72194), and CT abdomen pelvis combination tests (*74176-*74178) follows some specific rules:

  • When the imaging service is performed and it’s determined that a different CPT procedure(s) is more appropriate than the preauthorized CPT, the imaging facility or the ordering physician must contact AIM Specialty Health to change the order. The office that changed the order (imaging facility or ordering physician) must withdraw the original request and obtain authorization for the new procedure.
  • In these specific circumstances, we provide a post-procedure window of up to 60 days for the ordering or servicing providers to obtain the new authorization. AIM may perform a retrospective review either by phone or online.  Contact AIM at 1-800-728-8008 or aimspecialtyhealth.com.**
  • To prevent retrospective reviews and comply with the preauthorization program, all imaging providers are required to obtain a valid authorization before performing these scans.

If you have any questions, contact your Blue Cross provider consultant.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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