CurrentUnitedHealthcarePolicy N/A

Medicare Advantage radiology prior authorization crosswalk table

Provides a crosswalk table mapping submitted CPT codes to UnitedHealthcare Medicare Advantage prior-authorization CPT equivalents and short descriptions; affects billing and prior-authorization processing for providers submitting radiology/nuclear medicine CPTs.

Policy Summary

PayerUnitedHealthcare

PolicyMedicare Advantage radiology prior authorization crosswalk table

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionUse the crosswalk to map submitted CPT codes to the CPT code associated with UnitedHealthcare prior authorization when submitting claims for PET/SPECT and related radiology procedures.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20+document chunks in this part

multipleCPT crosswalk mappings shown

16+approximately distinct CPT mappings

PET/SPECTfocus

Coverage Criteria and Crosswalk Examples

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Crosswalk criteria examples

Mappings and prior-authorization indicators are presented as pairings of 'Prior authorization given with this CPT code' and 'Claim is submitted with this CPT code' showing equivalences.

Example mapping: Prior authorization given with CPT 78014 (Thyroid Uptake Measurement).

ALL of the following

Claim is submitted with CPT 78014 and maps to prior-auth CPT 78012 (78014 = 78012).
Claim is submitted with CPT 78014 and maps to prior-auth CPT 78013 (78014 = 78013).
Claim is submitted with CPT 78014 and maps to prior-auth CPT 78015 (78014 = 78015).
Claim is submitted with CPT 78014 and maps to prior-auth CPT 78016 (78014 = 78016).

Example mapping: Prior authorization given with CPTs 78016 and 78018 for thyroid carc metastases imaging (limited area and whole body) as shown; claims submitted with related CPTs map to the prior-auth entries.

CPT crosswalk mappings

Code crosswalk mappings (examples):

Prior authorization given with CPT 78803 (Brain Imaging Tomographic SPECT).

ALL of the following

Claim submitted with 78803 may map to 78606 = 78802 (parathyroid/related mapping noted).
Claim submitted with 78803 maps to Parathyroid Imaging (78606 = 78070).

Prior authorization given with CPT 78804 (Brain Imaging Tomographic SPECT whole body / multi-day).

ALL of the following

Claim submitted with 78804 may map to 78606 = 78800 / 78801 / 78802 (multiple submitted-to-prior-auth equivalences recorded).

CPT Code Tables and Coding Details

Example CPT mappings from part 1CPT

78014	Thyroid Uptake Measurement / Thyroid Img W/Bf W/Quant Meas
78320	Bone/joint imaging tomographic SPECT
78451	Myocardial SPECT single study

PET imaging CPT groupCPT

78811	Pet Imaging Limited Area Chest Head/Neck
78812	Pet Imaging Skull Base To Mid-Thigh
78813	Pet Imaging Whole Body
78814	Pet Imaging Ct For Attenuation Limited Area
78815	PET CT attenuation skull base to mid-thigh
78816	Pet Imaging For Ct Attenuation Whole Body

SPECT/brain imaging CPT groupCPT

78803	Brain Imaging Tomographic SPECT / Rp Loclzj Tum/Dstrbj Agt Tomog Spect
78804	Brain Imaging Tomographic SPECT whole body multiple-day imaging

Prior authorization indicator — meaning

Indicator meaningEntry marks that UnitedHealthcare has granted prior authorization for the listed CPT code (i.e., ‘Prior authorization given with this CPT code’).

How it appearsShown as a paired statement in the crosswalk (e.g., '78014, Prior authorization given with this CPT® code...').

Action for providersWhen a CPT is listed as 'Prior authorization given with this CPT code,' providers should reference that CPT as the authorized procedure when reconciling claims.

ScopeUsed in the Medicare Advantage radiology crosswalk for PET/SPECT and other nuclear medicine imaging codes.

Provider Actionables and Prior Authorization Guidance

Prior Authorization

Prior authorization crosswalk mappings

Crosswalk indicates which CPT codes have an associated UnitedHealthcare prior authorization and maps submitted CPT codes to the CPT code the prior authorization applies to; examples include mappings for codes such as 78014, 78016, 78018 and others shown in the crosswalk table.

The table presents entries of the form 'Prior authorization given with this CPT code' paired with 'Claim is submitted with this CPT code' to show equivalences (e.g., 78014 mappings).
Providers should verify that the CPT submitted on the claim corresponds to the prior-authorization CPT listed in the crosswalk to ensure proper prior-auth processing.

Prior Authorization

Prior authorization — CPT crosswalk for PET/SPECT

The crosswalk lists PET and SPECT CPT codes for which prior authorization was given and shows the CPT codes that may be submitted on claims (examples include brain SPECT codes 78803/78804 and PET codes 78802/78803/78811 mappings).

SPECT: 78803 and 78804 are shown as 'Prior authorization given with this CPT code' with corresponding submitted-code mappings in the table.
PET: 78802, 78803 and 78811 appear in the PET crosswalk entries mapping prior-authorized CPTs to submitted CPT codes (e.g., 78802/78803 entries referencing 78811 equivalences).
Providers must reference the crosswalk when billing PET/SPECT procedures to align the submitted CPT with the prior-authorization CPT listed.

Definitions and Crosswalk Terminology

Crosswalk — definition

DefinitionA mapping that shows which CPT code submitted on a claim corresponds to the CPT code for which UnitedHealthcare has granted prior authorization (crosswalk).

PurposeTo equate submitted claim CPTs with the CPT code that holds the prior authorization so claims are processed against the authorized procedure.

Example mappingsExamples in the crosswalk include mappings between submitted codes and prior-auth codes for thyroid, brain SPECT, and PET imaging (see listed code pairs).

Use in workflowProviders and billing staff should consult the crosswalk when the submitted CPT differs from the prior-authorized CPT to ensure correct claim coding and adjudication.

Prior authorization given with this CPT code — definition

DefinitionThe CPT code identified in the crosswalk as having an approved prior authorization for the imaging procedure (e.g., '78811, Prior authorization given with this CPT® code = Pet Imaging Limited Area Chest Head/Neck').

Examples78811 (PET Imaging Limited Area Chest Head/Neck); 78812 (PET Imaging Skull Base To Mid-Thigh); 78803 (Brain Imaging Tomographic SPECT).

ImplicationThis CPT should be treated as the authorized procedure when resolving claim submissions that map to it.

Claim is submitted with this CPT code — definition

DefinitionThe CPT code that may be submitted on the claim and which the crosswalk maps to the prior‑authorization CPT (e.g., '78813, Claim is submitted with this CPT code = 78811').

ExamplesSubmitted CPTs: 78813 (may be submitted and map to 78811 or 78814); 78812 (may be submitted and map to 78814, 78815, 78816 or 78811).

Provider actionWhen submitting claims, use the submitted CPT code per the service provided; consult the crosswalk to determine which prior‑auth CPT it maps to for adjudication.

Policy Summary

PayerUnitedHealthcare

PolicyMedicare Advantage radiology prior authorization crosswalk table

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionUse the crosswalk to map submitted CPT codes to the CPT code associated with UnitedHealthcare prior authorization when submitting claims for PET/SPECT and related radiology procedures.

SourceLink

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