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Outpatient Imaging Management

February 04, 2010

On January 1, 2010, BlueCross BlueShield of South Carolina began requiring precertification for certain advanced imaging services for its commercial business, State Health Plan and Publix members. You can find an overview of the National Imaging Associates (NIA) program and instructions on the Radiology Precertification page. On behalf of BlueCross, NIA handles precertification for certain imaging services. NIA is an independent company. The page also includes a list of codes that require authorization.

Here are some advanced radiology services that do not require radiology precertification. If you perform one of the procedures in this table you don’t need to contact NIA or BlueCross BlueShield of South Carolina to get precertification.                                      

              Advanced Radiology CPT Codes that Do Not Require Precertification

 Procedure Code                                     Description
 70557 Magnetic resonance (e.g., proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (i.e., to assess for residual tumor or residual vascular malformation); without contrast material
 70558 Magnetic resonance (e.g., proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (i.e., to assess for residual tumor or residual vascular malformation); without contrast material
 70559 Magnetic resonance (e.g., proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (i.e., to assess for residual tumor or residual vascular malformation); without contrast material
 72292 CT-guided epidurography
 75571 CT heart without contrast with quantitative evaluation of coronary calcium
 77011 CT guidance for stereotactic localization 
 77012 CT guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation 
 77012 CT guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation 
 77013 CT guidance for, and monitoring of, parenchymal tissue ablation 
 77021 Magnetic resonance guidance for needle placement (e.g., for biopsy, needle aspiration, injection or placement of localization device) radiological supervision and interpretation 
 77022 Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation



*Note: These codes are generally rendered in a surgery center or hospital inpatient setting and are therefore not managed by NIA.

For more information, contact your Provider Education representative at 803-264-4730 or by e-mail at Provider.Education@bcbssc.com.

 

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