Radiology Prior Authorization CPT Code List ...

1 Radiology | Prior AuthorizationPCA-1-22-01799-VC-WEB_05262 022-POCPT codeDescriptionModality70450CT HEAD/BRN C-MATRLCT70460CT HEAD/BRN C+ MATRLCT70470CT HEAD/BRN C-/C+CT70480CT ORBIT SELLA/POST FOSSA/EAR C-MATRLCT70481CT ORBIT SELLA/POST FOSSA/EAR C+ M AT RLCT70482CT ORBIT SELLA/POST FOSSA/EAR C-/C+CT70486CT MAXLFCL AREA C-MATRLCT70487CT MAXLFCL AREA C+ MATRLCT70488CT MAXLFCL AREA C-/C+CT70490CT SOFT TISS NCK C-MATRLCT70491CT SOFT TISS NCK C+ MATRLCT70492CT SOFT TISS NCK C-/C+CT70496CT ANGIOGRAPHY HEAD W/CONTRAST/ NONCONTRASTCT70498CT ANGIOGRAPHY NECK W/CONTRAST/ NONCONTRASTCT71250CT THORAX C-MATRLCT71260CT THORAX C+ MATRLCT71270CT THORAX C-/C+CT71275CT ANGIOGRAPHY CHEST W/CONTRAST/ NONCONTRASTCT72125CT CRV SPI C-MATRLCT72126CT CRV SPI C+ MATRLCT72127CT CRV SPI C-/C+CT72128CT THRC SPI C-MATRLCT72129CT THRC SPI C+ MATRLCT72130CT THRC SPI C-/C+CT72131CT LMBR SPI C-MATRLCT72132CT LMBR SPI C+ MATRLCT72133CT LMBR SPI C-/C+CTUnitedHealthcare Community Plan Radiology Prior Authorization CPT code listThe table below contains the CPT and Healthcare Common Procedure Coding System codes that apply to our UnitedHealthcare Community Plan Radiology Prior Authorization program.

cpt code description modality 72132 ct lmbr spi c+ matrl ct 72133 ct lmbr spi c-/c+ ct 72191 ct angiography pelvis w/contrast/ noncontrast ct 72192 ct pelvis c-matrl ct 72193 ct pelvis c+ matrl ct 72194 ct pelvis c-/c+ ct 73200 ct uxtr c-matrl ct 73201 ct uxtr c+ matrl ct 73202 ct uxtr c-/c+ ct 73206 ct angiography upper extremity ct 73700 ct lxtr c-matrl ct 73701 ct lxtr c+ matrl ct

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