Prior authorization

Alert: Effective for service dates on and after 9/1/2020, the health plan is reinstating the prior authorization requirement for Chest CT scans, which was temporarily waived in response to the COVID-19 public health emergency

Required for outpatient procedures

The following outpatient radiology procedures require you to get prior authorization through NIA.

  • CT scan
  • Nuclear exercise
  • Tolerance test (ETT)
  • PET scan

Obtaining authorization

The ordering physician or clinic is responsible for getting authorization.

If you are providing any of the services above, you should verify that the necessary authorization has been obtained. Not having the necessary authorization could result in non-payment of your claim.

If imaging procedures are needed or performed during an emergency room and/or urgent care visit or in observation and inpatient facilities, they don't require authorization.

Additional resources