BlueCross BlueShield of Tennessee
Prior Authorization List Codes Under Management:
High Tech Imaging (HTI)
Overview
Starting January 2, 2025, Cohere Health, a patient journey optimization company, is designated as the preauthorization and utilization management vendor for BlueCross BlueShield for High Tech Imaging services.
Impacted Plans and Geographies
Impacted plans and geographies will include BlueCross BlueShield of Tennessee Commercial and Medicaid, for all eligible members.
Clinical Scope
Practices must use Cohere when requesting preauthorizations for any of the procedure codes or services listed in the table below.
All practices are encouraged to submit authorization requests electronically by registering* for a Cohere account. Only Cohere users can benefit from instant authorization decisions, if eligible. You can register for an account by using single sign on from Availity. Upon your first time entering the Cohere portal, you will be prompted to verify your account. |
* Exclusions apply. Please contact BlueCross BlueShield of Tennessee for more information.
Please note: If you are submitting a Medicare (BlueCare) retro-authorization, you must indicate that it is being submitted for one of the following reasons:
The Enrollee did not provide BlueCare Tennessee insurance information
The Enrollee ID Card was not issued
Medicare was incorrectly documented as primary
There was a coverage issue
Failure to do so will result in your authorization request being admin voided.
Use Cohere to obtain preauthorizations for the following procedure codes:
Please note that issuance of an approval decision for any preauthorization request does not represent a guarantee of payment. Always refer to BlueCross BlueShield of Tennessee’s official Prior Authorization Lists (PAL) for the most up to date prior authorization requirements, coverage policies, and related plan policies.
High Tech Imaging (Commercial and Medicaid) | High Tech Imaging (Commercial and Medicaid) | High Tech Imaging (Commercial and Medicaid) |
CPT Code | Clinical Service Name | Description |
70336 | MRI TMJ | Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) |
70450 | CT Head or Brain | Computed tomography, head or brain; without contrast material |
70460 | CT Head or Brain | Computed tomography, head or brain; with contrast material(s) |
70470 | CT Head or Brain | Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections |
70480 | CT Orbit/Ear/Fossa | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material |
70481 | CT Orbit/Ear/Fossa | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) |
70482 | CT Orbit/Ear/Fossa | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections |
70486 | CT Face or Sinus | Computed tomography, maxillofacial area; without contrast material |
70487 | CT Face or Sinus | Computed tomography, maxillofacial area; with contrast material(s) |
70488 | CT Face or Sinus | Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections |
70490 | CT Neck (Soft Tissue) | Computed tomography, soft tissue neck; without contrast material |
70491 | CT Neck (Soft Tissue) | Computed tomography, soft tissue neck; with contrast material(s) |
70492 | CT Neck (Soft Tissue) | Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections |
70496 | CT Angiography (CTA) Head | Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
70498 | Computed Tomography Angiography (CTA), Neck, CT Angiography (CTA) Neck, CT (CAT) Scan (Outpatient/Nonemergency) | Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
70540 | MRI Neck or Orbit or Face | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) |
70542 | MRI Neck or Orbit or Face | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) |
70543 | MRI Neck or Orbit or Face | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences |
70544 | MRA Head or Brain | Magnetic resonance angiography, head; without contrast material(s) |
70545 | MRA Head or Brain | Magnetic resonance angiography, head; with contrast material(s) |
70546 | MRA Head or Brain | Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences |
70547 | MRA Neck | Magnetic resonance angiography, neck; without contrast material(s) |
70548 | MRA Neck | Magnetic resonance angiography, neck; with contrast material(s) |
70549 | MRA Neck | Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences |
70551 | MRI Brain | Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material |
70552 | MRI Brain | Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) |
70553 | MRI Brain | Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences |
70554 | MRI Brain (Functional) | Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration |
70555 | MRI Brain (Functional) | Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing |
71250 | CT Chest | Computed tomography, thorax, diagnostic; without contrast material |
71260 | CT Chest | Computed tomography, thorax, diagnostic; with contrast material(s) |
71270 | CT Chest | Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections |
71275 | CT Angiography (CTA) Chest | Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing |
71550 | MRI Chest | Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) |
71551 | MRI Chest | Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s) |
71552 | MRI Chest | Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences |
71555 | MRA Chest | Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) |
72125 | CT Cervical Spine | Computed tomography, cervical spine; without contrast material |
72126 | CT Cervical Spine | Computed tomography, cervical spine; with contrast material |
72127 | CT Cervical Spine | Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections |
72128 | CT Thoracic Spine | Computed tomography, thoracic spine; without contrast material |
72129 | CT Thoracic Spine | Computed tomography, thoracic spine; with contrast material |
72130 | CT Thoracic Spine | Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections |
72131 | CT Lumbar Spine | Computed tomography, lumbar spine; without contrast material |
72132 | CT Lumbar Spine | Computed tomography, lumbar spine; with contrast material |
72133 | CT Lumbar Spine | Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections |
72141 | MRI Cervical Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material |
72142 | MRI Cervical Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) |
72146 | MRI Thoracic Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material |
72147 | MRI Thoracic Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) |
72148 | MRI Lumbar Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material |
72149 | MRI Lumbar Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) |
72156 | MRI Cervical Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical |
72157 | MRI Thoracic Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic |
72158 | MRI Lumbar Spine | Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar |
72159 | MRA Spinal Canal | Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) |
72191 | CT Angiography (CTA) Abdomen and Pelvis | Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
72192 | CT Pelvis | Computed tomography, pelvis; without contrast material |
72193 | CT Pelvis | Computed tomography, pelvis; with contrast material(s) |
72194 | CT Pelvis | Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections |
72195 | MRI Left Hip, MRI Pelvis, MRI Right Hip | Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) |
72196 | MRI Left Hip, MRI Pelvis, MRI Right Hip | Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) |
72197 | MRI Left Hip, MRI Pelvis, MRI Right Hip | Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences |
72198 | MRA Pelvis | Magnetic resonance angiography, pelvis, with or without contrast material(s) |
73200 | CT Right Arm (Humerus), CT Right Shoulder, CT Left Elbow, CT Right Elbow, CT Left Forearm or Hand, CT Left Wrist, CT Left Arm (Humerus), CT Left Shoulder, CT Right Forearm or Hand, CT Right Wrist | Computed tomography, upper extremity; without contrast material |
73201 | CT Right Arm (Humerus), CT Right Shoulder, CT Left Elbow, CT Right Elbow, CT Left Forearm or Hand, CT Left Wrist, CT Left Arm (Humerus), CT Left Shoulder, CT Right Forearm or Hand, CT Right Wrist | Computed tomography, upper extremity; with contrast material(s) |
73202 | CT Right Arm (Humerus), CT Right Shoulder, CT Left Elbow, CT Right Elbow, CT Left Forearm or Hand, CT Left Wrist, CT Left Arm (Humerus), CT Left Shoulder, CT Right Forearm or Hand, CT Right Wrist | Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections |
73206 | CT Angiography (CTA) Upper Extremity | Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
73218 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) |
73219 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) |
73220 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences |
73221 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) |
73222 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) |
73223 | MRI Left Shoulder, MRI Right Shoulder, MRI Right Wrist, MRI Left Arm (Humerus), MRI Left Elbow, MRI Right Arm (Humerus), MRI Right Elbow, MRI Right Forearm (Radius/Ulna) MRI Left Hand, MRI Left Forearm (Radius/Ulna), MRI Left Wrist, MRI Right Hand | Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences |
73225 | MRA Upper Extremity | Magnetic resonance angiography, upper extremity, with or without contrast material(s) |
73700 | CT Right Ankle, CT Right Leg (Tib/Fib), CT Left Foot, CT Left Leg (Tib/Fib), CT Pelvis, CT Right Hip, CT Left Hip, CT Right Foot, CT Left Ankle, CT Left Knee, CT Left Thigh (Femur), CT Right Knee, CT Right Thigh (Femur) | Computed tomography, lower extremity; without contrast material |
73701 | CT Right Ankle, CT Right Leg (Tib/Fib), CT Left Foot, CT Left Leg (Tib/Fib), CT Pelvis, CT Right Hip, CT Left Hip, CT Right Foot, CT Left Ankle, CT Left Knee, CT Left Thigh (Femur), CT Right Knee, CT Right Thigh (Femur) | Computed tomography, lower extremity; with contrast material(s) |
73702 | CT Right Ankle, CT Right Leg (Tib/Fib), CT Left Foot, CT Left Leg (Tib/Fib), CT Pelvis, CT Right Hip, CT Left Hip, CT Right Foot, CT Left Ankle, CT Left Knee, CT Left Thigh (Femur), CT Right Knee, CT Right Thigh (Femur) | Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections |
73706 | CT Angiography (CTA) Lower Extremity | Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
73718 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) |
73719 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) |
73720 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences |
73721 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material |
73722 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) |
73723 | MRI Left Knee, MRI Left Ankle, MRI Left Foot, MRI Left Hip, MRI Left Leg (Tib/Fib), MRI Pelvis, MRI Right Hip, MRI Right Knee, MRI Left Thigh, MRI Right Ankle, MRI Right Foot, MRI Right Leg (Tib/Fib), MRI Right Thigh, | Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences |
73725 | MRA Lower Extremity | Magnetic resonance angiography, lower extremity, with or without contrast material(s) |
74150 | CT Abdomen | Computed tomography, abdomen; without contrast material |
74160 | CT Abdomen | Computed tomography, abdomen; with contrast material(s) |
74170 | CT Abdomen | Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections |
74174 | CT Angiography (CTA) Abdomen and Pelvis | Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
74175 | CT Angiography (CTA) Abdomen and Pelvis | Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
74176 | CT Abdomen and Pelvis | Computed tomography, abdomen and pelvis; without contrast material |
74177 | CT Abdomen and Pelvis | Computed tomography, abdomen and pelvis; with contrast material(s) |
74178 | CT Abdomen and Pelvis | Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions |
74181 | MRI Abdomen | Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) |
74182 | MRI Abdomen | Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) |
74183 | MRI Abdomen | Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences |
74185 | MRA Abdomen | Magnetic resonance angiography, abdomen, with or without contrast material(s) |
74261 | CT Colonography (Diagnostic) | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material |
74262 | CT Colonography (Diagnostic) | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed |
74263 | CT Colonography (Diagnostic) | Computed tomographic (CT) colonography, screening, including image postprocessing |
75557 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function without contrast material; |
75559 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging |
75561 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; |
75563 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging |
75565 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) |
75571 | CT Cardiac | Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium |
75572 | CT Cardiac | Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) |
75573 | CT Cardiac | Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of left ventricular [LV] cardiac function, right ventricular [RV] structure and function and evaluation of vascular structures, if performed) |
75574 | CCTA (Coronary CT Angiography) | Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) |
75635 | CT Angiography (CTA) Abdomen and Pelvis | Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing |
76376 | 3D Imaging | 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation |
76377 | 3D Imaging | 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation |
76380 | Follow-up/Limited CT for Lower Extremities, Computed Tomography Angiography (CTA), Chest with or without abdomen and pelvis (and branch vessels), Aortic Dissection, Follow-up/Limited CT for Brain, Follow-up/Limited CT for Orbit or Ear, Follow-up/Limited CT for Abdomen or Pelvis, Follow-up/Limited CT for Chest, Follow-up/Limited CT for Upper Extremities | Computed tomography, limited or localized follow-up study |
76390 | MR Spectroscopy | Magnetic resonance spectroscopy |
76391 | MR Elastography | Magnetic resonance (eg, vibration) elastography |
77046 | MRI Left Breast, MRI Right Breast | Magnetic resonance imaging, breast, without contrast material; unilateral |
77047 | MRI Bilateral Breasts | Magnetic resonance imaging, breast, without contrast material; bilateral |
77048 | MRI Left Breast, MRI Right Breast | Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral |
77049 | MRI Bilateral Breasts | Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral |
77084 | MRI Bone Marrow | Magnetic resonance (eg, proton) imaging, bone marrow blood supply |
78429 | Cardiac PET (Myocardial viability) | Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan |
78430 | Cardiac PET (Perfusion) | Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography |
78431 | Cardiac PET (Perfusion) | Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography (CT) transmission scan |
78432 | Cardiac PET (both viability and perfusion) | Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); |
78433 | Cardiac PET (both viability and perfusion) | Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan |
78451 | Myocardial Perfusion Imaging Single Photon Emission Computed Tomography (MPI-SPECT) | Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) |
78452 | Myocardial Perfusion Imaging Single Photon Emission Computed Tomography (MPI-SPECT) | Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection |
78453 | MPI-SPECT | Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) |
78454 | MPI-SPECT | Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection |
78459 | Cardiac PET (Myocardial viability) | Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; |
78466 | Multiple Gated Acquisition (MUGA) Scan | Myocardial imaging, infarct avid, planar; qualitative or quantitative |
78468 | Multiple Gated Acquisition (MUGA) Scan | Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique |
78469 | Multiple Gated Acquisition (MUGA) Scan | Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification |
78472 | Multiple Gated Acquisition (MUGA) Scan | Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing |
78473 | Multiple Gated Acquisition (MUGA) Scan | Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification |
78481 | Multiple Gated Acquisition (MUGA) Scan | Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification |
78483 | Multiple Gated Acquisition (MUGA) Scan | Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification |
78491 | Cardiac PET (Perfusion) | Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic) |
78492 | Cardiac PET (Perfusion) | Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic) |
78494 | Multigated acquisition (MUGA) scan | Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing |
78496 | Multiple Gated Acquisition (MUGA) Scan | Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure) |
78608 | Brain PET | Brain imaging, positron emission tomography (PET); metabolic evaluation |
78609 | Brain PET (Perfusion) | Brain imaging, positron emission tomography (PET); perfusion evaluation |
78811 | Brain PET, PET Scan/PET-CT | Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) |
78812 | PET Scan/PET-CT | Positron emission tomography (PET) imaging; skull base to mid-thigh |
78813 | PET Scan/PET-CT | Positron emission tomography (PET) imaging; whole body |
78814 | Brain PET, PET Scan/PET-CT | Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck) |
78815 | PET Scan/PET-CT | Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh |
78816 | PET Scan/PET-CT | Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body |
C8900 | MRA Abdomen | Magnetic resonance angiography with contrast, abdomen |
C8901 | MRA Abdomen | Magnetic resonance angiography without contrast, abdomen |
C8902 | MRA Abdomen | Magnetic resonance angiography without contrast followed by with contrast, abdomen |
C8903 | MRI Left Breast, MRI Right Breast, | Magnetic resonance imaging with contrast, breast; unilateral |
C8905 | MRI Left Breast, MRI Right Breast, | Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral |
C8906 | MRI Bilateral Breasts | Magnetic resonance imaging with contrast, breast; bilateral |
C8908 | MRI Bilateral Breasts | Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral |
C8909 | MRA Chest | Magnetic resonance angiography with contrast, chest (excluding myocardium) |
C8910 | MRA Chest | Magnetic resonance angiography without contrast, chest (excluding myocardium) |
C8911 | MRA Chest | Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) |
C8912 | MRA Lower Extremity | Magnetic resonance angiography with contrast, lower extremity |
C8913 | MRA Lower Extremity | Magnetic resonance angiography without contrast, lower extremity |
C8914 | MRA Lower Extremity | Magnetic resonance angiography without contrast followed by with contrast, lower extremity |
C8918 | MRA Pelvis | Magnetic resonance angiography with contrast, pelvis |
C8919 | MRA Pelvis | Magnetic resonance angiography without contrast, pelvis |
C8920 | MRA Pelvis | Magnetic resonance angiography without contrast followed by with contrast, pelvis |
C8931 | MRA Spinal Canal | Magnetic resonance angiography with contrast, spinal canal and contents |
C8932 | MRA Spinal Canal | Magnetic resonance angiography without contrast, spinal canal and contents |
C8933 | MRA Spinal Canal | Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents |
C8934 | MRA Upper Extremity | Magnetic resonance angiography with contrast, upper extremity |
C8935 | MRA Upper Extremity | Magnetic resonance angiography without contrast, upper extremity |
C8936 | MRA Upper Extremity | Magnetic resonance angiography without contrast followed by with contrast, upper extremity |
C9762 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging |
C9763 | Cardiac (Heart) MRI | Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging |
C9791 | MRI Chest | Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent |
G0219 | PET Scan/PET-CT | Pet imaging whole body; melanoma for non-covered indications |
G0235 | PET Scan/PET-CT | Pet imaging, any site, not otherwise specified |
G0252 | PET Scan/PET-CT, Cardiac PET | Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes) |
S8037 | MRCP | Magnetic resonance cholangiopancreatography (mrcp) |
S8042 | MRI Low Field | Magnetic resonance imaging (mri), low-field |
S8092 | CT Ultrafast | Electron beam computed tomography (also known as ultrafast ct, cine ct) |