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Effective: 1/1/2021CategoryCPT Code2CPT Code DescriptionPrior Authorization Required3DI763763D Rendering W/O PostprocessingYes3DI763773D Rendering W PostprocessingYesBMRI77046Magnetic resonance imaging, breast, without contrast material; unilateralYesBMRI77047Magnetic resonance imaging, breast, without contrast material; bilateralYesBMRI77048Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateralYesBMRI77049Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateralYesCardiac Implantables33274Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging gu

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3d image postprocessing, assessment of lv cardiac function, rv structure and function and evaluation of venous structures, if performed) Yes CCTA: 75574

  Disease, Cardiac

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