Authorization radiological procedures 2025

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For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies.
Prior authorization may be required for these advanced outpatient imaging procedures: CT scans* MRIs* MRAs*
Examples of services or procedures for which prior authorization may be needed include: admission to a hospital or skilled nursing facility. planned surgery. certain imaging tests, like an MRI or a computed tomography (CT) scan.
Ultrasound and diagnostic x-rays do not require prior authorization.
Services That Require Prior Authorization Diagnostic imaging (such as MRIs, CTs, and PET scans) Durable medical equipment (such as wheelchairs) Rehabilitation (like physical or occupational therapy) Home health services (such as nurses) Non-emergency surgery (elective surgery)
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If youre unable to obtain the authorization online, call the number on the back of the patients insurance card. Ask the representative if pre-authorization is needed for this exam. Most CTs, MRIs and Pet scans will need one.
Things like diagnostic images and complex care need prior authorization before you are treated. Prior authorization for MRIs and CT scans is standard. Your care provider will know to ask first, but dont be afraid to make sure. Each plan is different, so its always good to ask.

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