How to bill for radiology services

Billing for low-tech radiology services in a practitioner office

Priority Health privileges certain provider group specialties to perform in-office low-tech radiology services.
To find out which services your specialty is privileged to perform, contact your provider account executive.

• Providers may order any test, but Priority Health will only pay for those tests for which the provider is privileged.
• The privileging program is determined by Priority Health and American Imaging Management chief medical officers with local physician input. It is reviewed annually and amended as necessary.
• Refer members requiring other tests and exams to network radiology centers or hospitals.
• Learn about pending changes to this program.
• Learn about denials of claims and the appeals process.

Low-tech radiology services include:

• Plain film x-rays
• Ultrasounds
• GI studies
• Mammography
• Fluoroscopy
• Non-invasive vascular procedures
• Imaging guidance & contrast

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High-tech diagnostic radiology payment is determined through prior notification

High-tech diagnostic radiology services include CT, CTA, MRI, MRA, PET scans and nuclear cardiology studies.

To be payable: 

• The ordering provider must notify American Imaging Management (AIM) that they are requesting the service.
• The radiology facility must receive an RQI number from AIM before performing the service.

Go to details in the Authorizations section of this manual.

What to do if your claim is denied.