Cohere Health’s Scope of Management, Diagnostic Imaging: Prior Authorization List
Overview
Cohere Health a patient journey optimization company, is designated the preauthorization and utilization management vendor for Humana’s diagnostic imaging, cardiology, endoscopy, and musculoskeletal services. Cohere began managing musculoskeletal services in 2021 and 2022, and cardiology, and endoscopy in 2023.
Impacted Plans and Geographies
Impacted plans and geographies will include most Humana Medicare Advantage and Commercial plans in all 50 states and the District of Columbia.
Exclusions apply. For instance, Cohere will not be used for members with Medicare HMO policies in FL & CA. These members will continue to get authorizations through their primary care provider. Please contact Humana for more information.
Please note 2026 changes:
Beginning January 1, 2026, new requests for Humana Diagnostic Imaging for Florida members should be submitted through the Availity Essentials portal. Please navigate to http://essentials.availity.com.
Beginning July 1, 2026, all new requests for Humana Diagnostic Imaging for Humana members who reside in the states of Virginia, North Carolina, South Carolina, and Georgia should be submitted through the Availity Essentials portal at http://essentials.availity.com. If you require assistance on a request submitted before July 1st, Cohere Health is still able to assist.
Clinical Scope
Practices must use Cohere when requesting preauthorizations for any of the procedure codes or services listed in the table below.
All physicians who request/order radiology services are required to obtain a prior authorization for services prior to the service being rendered in an office or outpatient setting.
For more information and to view the official and most up to date Humana Prior Authorization List (PAL), please visit Humana’s provider website (www.humana.com/PAL). Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Use Cohere to obtain preauthorizations for the following procedure codes:
Diagnostic Imaging |
|
Service Category | Procedure codes (HCPCS) |
Computed Tomography (CT) | 70460, 70470, 70471, 70481, 70482, 70487, 70488, 70491, 70492, 70496, 70498, 71260, 71270, 71275, 72126, 72127, 72130, 72132, 72133, 72191, 72193, 72194, 73206, 73706, 74160, 74170, 74174, 74175, 74177, 74178, 75572, 75573, 75574, 75635 |
Magnetic Resonance Angiogram (MRA) | 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936 |
Magnetic Resonance Imaging (MRI) | 70336, 70540, 70542, 70543, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73718, 73719, 73720, 73721, 73722, 73723, 74181, 74182, 74183, 75557, 75559, 75561, 75563, 77046, 77047, 77048, 77049, C8903, C8905, C8906, C8908, C9762, C9763, C9791 |
Positron Emission Tomography (PET Scan)/National Oncology PET Registry | 78429, 78430, 78431, 78432, 78433, 78459, 78491, 78492, 78608, 78811, 78812, 78813, 78814, 78815, 78816 |
Prostate-specific Membrane Antigen (PSMA/PET CT) | A9587, A9593, A9594, A9596, A9597, A9595, A9608, A9616, A9800 |
Please note that issuance of an approval decision for any preauthorization request does not represent a guarantee of payment. Always refer to Humana’s official Prior Authorization Lists (PAL) at www.humana.com/pal for the most up to date prior authorization requirements, coverage policies, and related plan policies.