Prior Authorization is required for the following radiology codes:
PET SCANS
78459 Myocardial -metabolic
78491 Myocardial-single-rest/stress
78492 Myocardial,perfusion-mult.
78608 Brain-metabolic
78609 Brain, perfusion
78811 Limited area
78812 Skull base to mid-thigh
78813 Whole body
78814 w/CT; limited area
78815 w/CT skull base to mid-thigh
78816 w/CT whole body
CTA
70496 Head
70498 Neck
71275 Chest (non-coronary)
72191 Pelvis
73206 Upper extremity
73706 Lower extremity
74175 Abdomen
75635 Aortobifemoral runoff
