Skip to content Priority Health
Sections

Radiology authorizations

CPT Code List

Here's a list of the CPT codes for diagnostic radiology services that require prior authorization. Print it now (48KB PDF).

Low-tech radiology authorizations

Low-tech radiology services performed in participating provider offices do not require authorization. However, they are only payable when the participating provider is privileged under their specialty to perform them.
Learn about credentialing by specialty.

High-tech radiology authorizations


Participating providers:

Request prior authorization for most Priority Health patients through American Imaging Management (AIM) before ordering high-tech radiology studies and exams. See "Requesting high-tech imaging authorizations," below.

Out-of-network providers:

Request authorization for high-tech radiology services by completing the general prior authorization request form (515KB PDF) or by calling the Provider Help Line if needed. Choose the "authorization" option.  


Exceptions to the requirement for prior authorization of high-tech imaging studies


Prior Authorization
is REQUIRED FOR:		 EXCEPTIONS:
  • CT/CTA
  • MRI
  • MRA
  • Nuclear cardiac studies
  • PET scans
  • Emergency department or urgent care facility
  • Services related to same-day outpatient surgeries
  • Inpatient stays
  • Observation
  • Patients covered by Priority Health Medigap (Medicare Supplement insurance) plans
  • Patients covered by certain employers

Requesting high-tech imaging prior authorizations

Choose one of three methods to submit the required information to receive an authorization number.
  1. Recommended: Log in to the AIM website at www.providerportal.com 24 hours a day, 7 days a week.
      • Requests may be approved in real time and authorization numbers provided immediately.
      • You will receive an $8-per-order incentive for each successful submission (supplying complete clinical information meeting medical necessity criteria, leading to an immediate Web-issued authorization number).
      • If you do not have an AIM account, you must register first.
    OR
  2. Call AIM toll-free at 800 552-0020, Monday through Friday, 8am to 5pm EST.
    3. OR
  3. Complete the AIM authorization request fax form (38KB PDF) and fax it to 800 610-0050. AIM will fax an authorization number to you. This is the slowest method of receiving authorization.

Add-on procedure requests

To request add-on procedures to an existing authorization, call AIM within 5 business days of service at 800 552-0020. Specify the existing authorization number. These requests can be made by either the servicing or ordering provider.

Urgent procedure requests

Ordering providers must call AIM within 5 business days of service at 800 552-0020 when you have already performed urgent procedures. You must specify that the services were urgent when you call.

Retroactive requests

Requests other than those for add-on or urgent procedures (see above) will not be accepted.

Change a previously authorized procedure

(Example: CT ordered, CTA needed) The ordering physician should call and obtain a new authorization number prior to the service being performed. Follow the procedure for requesting a new authorization.

More information about the prior authorization process


Last modified 03/08/10