imaging services not requiring pre-certification, HealthPlus believes that
accredited radiology facilities should be used to ensure that the technical and
professional components of all diagnostics are of the highest quality. We
also recognize that in order to appropriately diagnose and treat members in a
timely manner, there are instances in which it is appropriate for some imaging
to occur in the physician’s office. Therefore, HealthPlus allows certain
CPT codes to be billed to HealthPlus by the treating physician. The codes
are automatically released by physician specialty, as documented on the
HealthPlus Privileging by Specialty list.
is our expectation that imaging performed in the physician’s office meets
certain professional standards, including the following:
Imaging films/reports for HealthPlus members are subject to audit.
nuclear medicine (e.g., CPT codes* 78451, 78452, 78453, 78454, 78466, 78468,
78469, 78472, 78473, 78481, 78483, 78494, 78496), selected diagnostic
ultrasound (e.g., CPT codes* 76801 - 76814, 76818 – 76821) and fetal
echocardiography (e.g., CPT codes* 76825, 76826, 76827, 76828), HealthPlus
requires that the physician and/or provider office is accredited by the
Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL),
the American College of Radiology (ACR), the Intersocietal Commission for the
Accreditation of Echocardiography Laboratories (ICAEL) or the American
Institute of Ultrasound Medicine (AIUM). Providers who wish to perform
these procedures in the office for HealthPlus members must complete a
HealthPlus Facility Assessment Tool for In-Office Diagnostic Imaging.
Documentation of accreditation must be submitted to HealthPlus with the tool.
CPT codes current as of August 2010, but are subject to change.
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