CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Medicare Advantage High Tech Imaging Prior Authorization List

A payer list of high-tech imaging CPT/HCPCS codes that require prior authorization for Medicare Advantage members served by BlueCross BlueShield of Tennessee; specifies allowable billable groupings and notes exclusions and billing guidance.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyMedicare Advantage High Tech Imaging Prior Authorization List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders must obtain prior authorization for listed high‑tech imaging CPT/HCPCS codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~100+imaging procedure codes listed (CT, MRI, MRA, PET, etc.)

multipleexplicit allowable billed groupings for many codes

exclusions listedservices explicitly excluded from Covered Services

2026policy year in title

Prior Authorization and Billing Criteria

Codes listed require prior authorization for Medicare Advantage members; allowable billed groupings and billing guidance are provided. Certain services are explicitly excluded.

Prior authorization required for listed high-tech imaging CPT/HCPCS codes for Medicare Advantage members.

Allowable Billed Groupings: many codes include specified related codes that may be billed together; follow the listed Allowable Billed Groupings for each CPT/HCPCS code.

Payment considerations

Payment for add-on codes may depend on the appropriateness of the application of such codes relative to the approved primary code.

Excluded services: Covered Services specifically exclude mammography; inpatient radiology services; radiology services rendered in an emergency department of a hospital; radiation therapy services; interventional radiology procedures; services provided outside the BCBS TN service area for fully insured commercial members; and all other outpatient diagnostic services other than MRI, MRA, MRS, CT or PET services.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyMedicare Advantage High Tech Imaging Prior Authorization List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders must obtain prior authorization for listed high‑tech imaging CPT/HCPCS codes.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Representative High‑Tech Imaging Codes

Representative high-tech imaging codes requiring prior authorizationCPTCovered

70336	MRI Temporomandibular Joint
70450	CT Head/Brain
70551	MRI Brain (with or without Internal Auditory Canal views)
71250	CT Chest
74150	CT Abdomen

PET / nuclear cardiology codesmixedCovered

78813	PET Scan
78816	PET Scan with concurrently acquired CT for attenuation correction
G0252	PET imaging, initial diagnosis of breast cancer and/or surgical planning for breast cancer

PET/CT coding guidance — when PET and diagnostic CT performed simultaneously bill both and append CT with modifier 59 guidance

Billing when PET and diagnostic CT performed simultaneouslyBill both the PET CPT code and the CT code describing the body region and procedure performed; append the CT code with modifier 59 per CPT guidance.

NIA review and determinationsNIA will review medical necessity for both the PET and CT codes when submitted and will issue utilization management determinations for each code.

Use of 78814-series vs PET fusionThe 78814 series (PET with CT for attenuation correction) is acceptable when PET is indicated, but these codes are NOT to be used for studies typically called PET fusion.

Add-on code payment notePayment for add-on codes may depend on the appropriateness of their application relative to the approved primary code.

Provider Requirements and Required Codes

Prior Authorization

Prior Authorization Required

Prior authorization is required for the listed CPT/HCPCS imaging codes for Medicare Advantage members. Providers must obtain authorization before scheduling or performing these services to avoid claim denials.

70336 — MRI Temporomandibular Joint (Allowable billed groupings: 70336)
70450 — CT Head/Brain (Allowable billed groupings: 70450, 70460, 70470, 0722T)
70480 — CT Orbit (Allowable billed groupings: 70480, 70481, 70482, 0722T)
70486 — CT Maxillofacial/Sinus (Allowable billed groupings: 70486, 70487, 70488, 76380, 0722T)
70490 — CT Soft Tissue Neck (Allowable billed groupings: 70490, 70491, 70492, 0722T)
70496 — CT Angiography, Head (Allowable billed groupings: 70496)
70498 — CT Angiography, Neck (Allowable billed groupings: 70498)
70540 — MRI Orbit, Face, and/or Neck (Allowable billed groupings: 70540, 70542, 70543, +0698T)
70544 — MRA Head (Allowable billed groupings: 70544, 70545, 70546)
70547 — MRA Neck (Allowable billed groupings: 70547, 70548, 70549)
70551 — MRI Brain (with or without Internal Auditory Canal views) (Allowable billed groupings: 70551, 70552, 70553, +0698T)
70554 — Functional MRI Brain (Allowable billed groupings: 70554, 70555)
71250 — CT Chest (Allowable billed groupings: 71250, 71260, 71270, 0722T)
71275 — CT Angiography, Chest (non coronary) (Allowable billed groupings: 71275)
71550 — MRI Chest (Allowable billed groupings: 71550, 71551, 71552)

Key Terms and Billing Groupings

PET fusion — definition/brief note

DefinitionPET fusion is a study where a PET scan and a diagnostic CT scan are performed on the same machine simultaneously.

Coding implicationCPT instructs billing both the PET CPT code and the CT code for the body region when PET fusion is performed; append the CT with modifier 59.

Distinction from 78814-seriesThe 78814 series (PET with CT for attenuation correction) is not the same as PET fusion and should not be used to represent PET fusion studies.

Allowable Billed Groupings — explanation

Allowable Billable Groupings — general meaningCodes that may be billed together or are considered related for authorization and payment purposes; the list has been expanded to reflect PET techniques.

78814-series inclusionThe 78814 series (PET with CT for attenuation correction) is acceptable when PET is clinically indicated and is included within allowable groupings; this does not substitute for PET fusion coding.

Billing when codes are relatedWhen a PET and diagnostic CT are truly performed together (PET fusion), both codes should be billed and processed; NIA will review medical necessity for each billed code.