CurrentUnitedHealthcarePolicy N/A

Radiology prior authorization crosswalk for commercial and Individual Exchange plans

Provides a crosswalk mapping of CPT codes showing which CPT code prior authorizations were given for and which CPT codes claims may be submitted with for UnitedHealthcare commercial and Individual Exchange (ACA Marketplace) plans.

Policy Summary

PayerUnitedHealthcare

PolicyRadiology prior authorization crosswalk for commercial and Individual Exchange plans

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse the crosswalk table to determine which claim-submitted CPT corresponds to the CPT given prior authorization for outpatient radiology services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Commercial & Exchangeplans referenced

CT, MRI, MRAmodalities

FFR-CTadvanced imaging

chunks 18-37document portion

Coverage Criteria and Crosswalks

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.

Radiology CPT crosswalk mappings (partial)

Radiology CPT crosswalk mappings (partial) — examples showing the CPT code under which prior authorization was granted and the CPT code(s) expected on the claim submission.

72132: Prior authorization given with this CPT code = CT LMBR SPI C+ MATRL. Claim(s) submitted may be: 72131, 72133, 76380, CT LMBR SPI C-MATRL, CT LMTD/LOCLZD F-UP STD.

72133: Prior authorization given with this CPT code = CT LMBR SPI C+ MATRL (maps to CT LMBR SPI C-/C+). Claim(s) submitted may be: 72131, 72132, 76380, CT LMBR SPI C-MATRL, CT LMBR SPI C+ MATRL, CT LMTD/LOCLZD F-UP STD.

72142: Prior authorization given with this CPT code = CT LMBR SPI C+ MATRL (maps to MRI SPI CANAL&CNTS CRV C+ MATRL). Claim(s) submitted may include 72131 (and related local codes as clinically appropriate).

CPT / Procedure Code Crosswalk Tables

sample CT head crosswalk entriesCPT

70450	CT HEAD/BRN C-MATRL (prior authorization given) — claim-submitted equivalents include 70460, 70470, 76380, CT LMTD/LOCLZD F-UP STD
70460	CT HEAD/BRN C+ MATRL (prior authorization given) — claim-submitted equivalents include 70450, 70470, 76380, CT LMTD/LOCLZD F-UP STD

sample CT thorax crosswalk entriesCPT

71250	CT THORAX C-MATRL (prior authorization given) — claim-submitted equivalents include 71260, 71270, 71271, 76380, CT LMTD/LOCLZD F-UP STD
71260	CT THORAX C+ MATRL (prior authorization given) — claim-submitted equivalents include 71250, 76380, CT LMTD/LOCLZD F-UP STD

Example CPT mappings (partial)CPT

72132	Prior authorization given with this CPT code (CT LMBR SPI C+ MATRL) — claim-submitted equivalents include 72131, 72133, 76380, CT LMTD/LOCLZD F-UP STD
72133	Related prior-authorization and claim submission mapping entries (CT LMBR SPI C+ MATRL/ C- variants) — claim-submitted equivalents include 72131, 72132, 76380, CT LMTD/LOCLZD F-UP STD

Representative CPT crosswalk entriesCPT

73722	MRI/CT joint imaging crosswalk example (prior authorization given) — claim-submitted equivalents include 73701, 73720, 73721, 73723
74150	CT abdomen code used as prior authorization example (represented among abdominal imaging crosswalks)
78811	PET imaging limited area (prior authorization given) — claim-submitted equivalents include 78814, 78815, 78816

FFR-CT codesCPT

0501T	FFR-CT (GLOBAL)
0502T	FFR-CT (DATA PREP & TRANS)
0503T	FFR-CT (VENDOR TECH COMPONENT)
0504T	FFR-CT (INTER & REPORT - MD)

Radiology CPT mappingsCPT

78812	PET imaging skull base to mid-thigh (submitted)
78813	PET imaging whole body (submitted)
78814	PET imaging CT for attenuation limited area (submitted)
78815	PET imaging CT attenuation skull base to mid-thigh (submitted)
78816	PET imaging for CT attenuation whole body (prior authorization mapping target)
71250	CT thorax C-MATRL (submitted)
71271	CT thorax C-MATRL (Low Dose for Lung Cancer Screening) (prior authorization mapping target)
0501T	FFR-CT (GLOBAL)
0502T	FFR-CT (DATA PREP & TRANS)
0503T	FFR-CT (VENDOR TECH COMPONENT)

1–10 of 16

1/2

Provider Instructions and Billing Guidance

Billing Rule

FFR-CT mappings

Prior authorization and claim submission for FFR-CT (coronary CT-derived fractional flow reserve) codes follow a mapped crosswalk. When prior authorization is obtained for one FFR-CT CPT, the claim may be submitted using a different but corresponding CPT depending on the billing component performed. Verify the mapping below to ensure claim submission uses the correct CPT.

Prior authorization given with 0501T (FFR-CT, global). Claim may be submitted with 0502T (FFR-CT data prep & transmission), 0503T (FFR-CT vendor technical component), or 0504T (FFR-CT interpretation & report - MD) depending on services rendered.
Prior authorization given with 0502T (FFR-CT data prep & transmission). Claim may be submitted with 0501T (FFR-CT, global), 0503T (vendor technical component), or 0504T (interpretation & report - MD).
Prior authorization given with 0503T (FFR-CT vendor technical component). Claim may be submitted with 0501T (global), 0502T (data prep & transmission), or 0504T (interpretation & report - MD).
Prior authorization given with 0504T (FFR-CT interpretation & report - MD). Claim may be submitted with 0501T (global), 0502T (data prep & transmission), or 0503T (vendor technical component).

Prior Authorization

Radiology CPT prior authorization crosswalk

Prior authorization crosswalks for outpatient radiology list the CPT code(s) for which authorization was granted and the CPT code(s) that should be used when submitting the claim. Use these mappings to avoid denials or claim processing delays.

Example mappings (non-exhaustive):
- Prior authorization 71271 (CT thorax C+ material — low dose for lung cancer screening). Claim submitted as 71250 or 71271 depending on the performed service.
- Prior authorization 72132 / 72133 (CT lumbar spine with contrast/material variants). Claim submission may map among 72131, 72132, 72133, 76380 or other site-specific CT/MRI lumbar spine codes; select the CPT that accurately reflects the billed procedure.
- Prior authorization 73722 / 73723 (CT or MRI large joint codes). Authorized CT joint codes may be submitted as MRI joint CPTs (73701, 73718, 73719, 73720, 73721, 73723) depending on the performed imaging and technical components.
- Prior authorization 78816 (PET imaging for CT attenuation whole body). Claim submissions may be 78813, 78814, 78815 or descriptor-based PET CPTs for the actual area imaged.
- Prior authorization 78429–78433 (myocardial PET imaging series). Claim submission may map to CPTs such as 78459, 78491, 78492, or other appropriate myocardial PET CPTs based on study type and number of studies.
- Always bill the CPT that most accurately represents the service actually performed (technical vs global vs professional components). If multiple components are performed by different providers or vendors, submit the CPT(s) that correspond to each entity's performed component per the payer's billing guidance.

Definitions and Key Terms

Crosswalk table — definition

DefinitionCrosswalk table: mapping that shows the CPT code for which prior authorization was given and the CPT code(s) under which claims may be submitted.

PurposeUsed with the Outpatient radiology prior authorization program for commercial and Individual Exchange plans to relate prior-auth CPTs to claim-submitted CPTs.

ScopeAdministrative/code-mapping only; does not state clinical coverage criteria.

Crosswalk — definition & guidance

DefinitionCrosswalk: mapping between the CPT code associated with a prior authorization and the CPT code expected on the submitted claim.

Example behaviorEntries show a prior-authorized CPT (e.g., 72132) and claim-submitted equivalents (e.g., 72131, 72133, 76380).

UseFollow the mapping when submitting claims for services that received prior authorization to ensure correct claim CPTs are used.

Prior authorization mapping — definition

TermPrior authorization mapping = Prior authorization given with this CPT code.

Example73722 indicated as the CPT code for which prior authorization was given in the crosswalk entries.

Applies toOutpatient radiology services for UnitedHealthcare commercial and Individual Exchange plans.

Claim submission mapping — definition

TermClaim submission mapping = Claim is submitted with this CPT code.

ExampleEntries show claim-submitted codes (e.g., 73701, 73720, 72131) corresponding to prior-auth CPTs such as 73722 and 72132.

Action for providersSubmit the claim using the mapped claim CPT(s) indicated in the crosswalk for the prior-authorized service.

CPT trademark notice

Trademark noteCPT® is a registered trademark of the American Medical Association.

AttributionCPT terminology and codes are used under that trademark for coding radiology procedures in this crosswalk.

Legal/brandingInclude the CPT® trademark when reproducing CPT codes or descriptions from this policy.