Policy Impacted
MA09.002q High-Technology Radiology Services
Purpose
The purpose of this NewsFlash is to provide advance notice that medical necessity reviews will resume for new prior authorization requests on or after July 15, 2021 regarding the use of pharmacologic stress testing with nuclear imaging in lieu of exercise stress testing.
Background
Coverage Statement
Effective July 15, 2021 medical necessity reviews will resume for new prior authorization requests regarding the use of pharmacologic stress testing with nuclear imaging in lieu of exercise stress testing.
For the Company's plans that are subject to radiology utilization management through AIM Specialty Health® (AIM) for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services, AIM will use the updated Clinical Appropriateness Guidelines for Radiology to determine the medical necessity for these services.. To view AIM’s current and future guidelines, go to the Resources section of AIM’s website, available at https://aimspecialtyhealth.com/resources/.
Coding
CPT CODES
78430, 78431, 78451, 78452, 78453, 78454, 78491, 78492
