CurrentColorado Rocky Mountain Health PlansPolicy ADMINISTRATIVE 248.15

Accreditation Requirements for Radiology Services

Governs accreditation requirements for radiologists, radiology centers, and multi‑specialty provider groups participating in the Oxford network; specifies which outpatient diagnostic imaging modalities require facility accreditation as a condition for reimbursement.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAccreditation Requirements for Radiology Services

Policy CodePolicy ADMINISTRATIVE 248.15

Change TypeEditorial and scope clarifications

Effective DateDec 1, 2025

Next Review Date

Key ActionSubmit facility accreditations through the eviCore healthcare website; contact EviCore for prior authorization and accreditation support.

SourceLink

POLICY UPDATE CHANGES

Purpose language changed to clarify policy applies to groups participating in the Oxford network.

Replaced references to 'advanced imaging' with 'diagnostic imaging' and adjusted list of procedures requiring accreditation; removed stereotactic biopsy items and certain exception language.

Updated related policy references (Outpatient Cardiology and Outpatient Radiology for EviCore Arrangement).

MRI, CT, PET, Ultrasound, MammographyModalities listed

Freestanding facilities & physician officesEntities required

EviCoreThird party

1-800-666-1353

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Accreditation Requirement and Reimbursement

Accreditation and reimbursement criteria

Covered when ALL of the following are met:

All freestanding facilities and physician offices performing outpatient diagnostic radiology imaging studies must obtain and maintain accreditation to be reimbursed for the listed modalities.

Radiologists seeking reimbursement for diagnostic imaging must have the laboratory/facility accreditation on file.

Accreditation must be in the appropriate module for the modality: ACR for MRI, Breast MRI, CT, Nuclear Medicine, PET, Ultrasound, Breast Ultrasound, Mammography; AIUM for Ultrasound and Breast Ultrasound; IAC for MRI, CT, Nuclear Medicine, PET, Ultrasound.

This policy applies to radiology centers, radiologists, and multi‑specialty groups; for diagnostic imaging performed by primary care, specialty physicians, or other clinicians in office settings, refer to Oxford's Outpatient Imaging Self‑Referral Policy for accreditation and certification requirements.

This policy is NOT applicable to radiology services performed during an inpatient stay, ambulatory surgery, or emergency room visit.

Some radiology and cardiology procedures may also require prior authorization in addition to site‑of‑service review; contact EviCore or use the Prior Authorization and Notification App for prior authorization requirements.

Imaging Modalities Requiring Accreditation

Imaging modalities requiring accreditationmixed

MRI	MRI
CT	CT
Nuclear Medicine	Nuclear Medicine
PET	PET
Ultrasound	Ultrasound
Mammography	Mammography
Breast MRI	Breast MRI
Breast Ultrasound	Breast Ultrasound

What Providers Must Do / Contacts

Prior Authorization

Prior authorization required — contact EviCore

Some radiology and cardiology procedures require prior authorization in addition to a site‑of‑service review. Providers can call EviCore at 1-877-PreAuth (773-2884) or use the Prior Authorization and Notification App for submission and questions. For additional policy detail, refer to the Outpatient Radiology and Outpatient Cardiology Procedures for EviCore Arrangement policies and the MRI/CT Site of Service policy.

Prior authorization required in addition to site‑of‑service review for certain radiology and cardiology procedures.
Provider phone contact for EviCore: 1-877-PreAuth (773-2884).
Alternative submission: Prior Authorization and Notification App.

Documentation Required

Submit accreditations via eviCore website

Oxford has engaged EviCore Healthcare to manage accreditation submissions. Accreditations must be submitted directly to the eviCore healthcare website and include all applicable facility and physician information to ensure prompt handling.

Acronyms

ACRAmerican College of Radiology

AIUMAmerican Institute of Ultrasound in Medicine

IACIntersocietal Accreditation Commission

TJCThe Joint Commission