Outpatient Imaging Self-Referral Policy
Defines which outpatient imaging and diagnostic cardiology services may be self-referred by non-radiology/cardiology providers, applicable accreditation expectations, and prior authorization requirements for UnitedHealthcare members and participating providers.
Added language that this policy does not apply to cardiology services performed during an inpatient stay, ambulatory surgery, emergency room visit, or pre-operative/pre-admission testing.
Replaced wording about obtaining authorization via eviCore healthcare to explicitly reference diagnostic radiology or diagnostic cardiology procedures.
Clarified standard authorization number validity: valid for 45 calendar days and specific to the advanced outpatient imaging procedure, for one date of service within the authorization period.
Changed applicable cardiology CPT codes and specialty designation from Pediatric Cardiologists to Cardiologists for several codes.
Added RadSite as an acceptable accreditor for nuclear medicine laboratories.
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.