CurrentUnitedHealthcarePolicy N/A

UnitedHealthcare Community Plan of Maryland radiology prior authorization CPT/HCPCS code list

This document lists CPT and HCPCS radiology procedure codes that require prior authorization for UnitedHealthcare Community Plan of Maryland members and explains where to verify or initiate authorization requests.

Policy Summary

PayerUnitedHealthcare

PolicyCommunity Plan of Maryland radiology prior authorization code list

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionVerify if prior authorization is required or initiate a request by calling 866-889-8054 or visiting UHCprovider.com/radiology.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multiple hundredsCPT/HCPCS codes listed requiring prior authorization

MarylandPlan/state this list applies to

866-889-8054Phone to verify/initiate prior auth

UHCprovider.com/radiologyProgram details web page

Prior Authorization Required Procedures

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Prior authorization required codes

Codes listed below require prior authorization for Community Plan of Maryland members.

The following CPT and HCPCS procedure codes require prior authorization for UnitedHealthcare Community Plan of Maryland members.

Code list (excerpt)

0633T — CT BREAST W/3D UNI C- (Modality: CT)
0634T — CT BREAST W/3D UNI C+ (Modality: CT)
0635T — CT BREAST W/3D UNI C-/C+ (Modality: CT)
0636T — CT BREAST W/3D BI C- (Modality: CT)
0637T — CT BREAST W/3D BI C+ (Modality: CT)
0638T — CT BREAST W/3D BI C-/C+ (Modality: CT)
0710T — N-INVAS ARTL PLAQ ALYS DATA PRP QUAN REVIEW I&R (Modality: CT)
0711T — N-INVAS ARTL PLAQ ALYS DATA PREP & TRANSMISSION (Modality: CT)
0712T — N-INVAS ARTL PLAQ ALYS QUAN STRUX&COMPOS VSL WAL (Modality: CT)
0713T — N-INVAS ARTL PLAQ ALYS DATA REVIEW I&R (Modality: CT)
70450 — CT HEAD/BRN C-MATRL (Modality: CT)
70460 — CT HEAD/BRN C+ MATRL (Modality: CT)
70470 — CT HEAD/BRN C-/C+ (Modality: CT)
70480 — CT ORBIT SELLA/POST FOSSA/EAR C-MATRL (Modality: CT)
70481 — CT ORBIT SELLA/POST FOSSA/EAR C+ MATRL (Modality: CT)

CPT / HCPCS Code Lists

Selected CT codes (list is extensive)CPTCovered

0633T	CT BREAST W/3D UNI C-
70450	CT HEAD/BRN C-MATRL
71250	CT THORAX C-MATRL

Selected MR codes (list is extensive)CPTCovered

70336	MRI TMPRMAND JT
70540	MRI ORBIT FACE &/NECK W/O CONTRAST
70544	MRA HEAD C-MATRL

Selected NM/PET codesCPTCovered

78451	MYOCARDIAL SPECT MULTIPLE STUDIES
78429	MYOCRD IMG PET METAB EVAL, SINGLE STUDY W/CT
78811	PET IMAGING LIMITED AREA CHEST HEAD/ NECK

How to Verify or Initiate Prior Authorization

Prior Authorization

Verify or initiate prior authorization

Verify whether a radiology CPT/HCPCS code requires prior authorization for UnitedHealthcare Community Plan of Maryland members by calling 866-889-8054 or by visiting UHCprovider.com/radiology and selecting Community Plan (Medicaid) under Specific Radiology Programs.

Call 866-889-8054 to verify or initiate a prior authorization request.
Visit UHCprovider.com/radiology and click Community Plan (Medicaid) for program details and to initiate requests online.

Key Definitions

Prior authorization (definition and actions)

DefinitionPrior authorization is the process to verify if a listed radiology procedure requires approval before scheduling or to initiate a request by phone or web.

Where to verify/initiateCall 866-889-8054 to verify if prior authorization is required or to initiate a request.

Online detailsProgram effective dates and state-specific details are available at UHCprovider.com/radiology under 'Community Plan (Medicaid)'.

ScopeApplies to CPT and HCPCS radiology procedures listed for UnitedHealthcare Community Plan of Maryland members.

PurposeEnsures listed radiology procedures have approval prior to scheduling to meet plan requirements.