Outpatient Imaging Self-Referral (Commercial, Medicare, Medicaid) (Administered by EviCore by Evernorth)
Defines which outpatient imaging procedures are payable when self-referred by office-based providers, the provider specialties covered, and minimum certification/accreditation requirements; applies to EmblemHealth commercial, Medicare, and Medicaid members administered by EviCore (exclusions noted).
76942 added to provider specialties: Gastroenterologists and Pain Specialists; 76770 added to provider specialty: Urologists.
EviCore Healthcare name updated to EviCore by Evernorth and multiple CPT codes added across specialties (for example 93356, 78434, 77003).
Various CPT codes added in prior revisions including 76883, 76376, 76377, 75572-75574, and 76856.
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.