Prior Approval is now needed for some imaging procedures

In an effort to control medical costs, under the benefits of certain plans with Blue Cross Blue Shield of North Carolina (BCBSNC) the following diagnostic imaging services that are received in an outpatient setting, such as in your doctor’s office, the outpatient department of a hospital or at a freestanding imaging center may require prior plan approval (for dates of service on or after February 15, 2007):

• CT/CTA scans
• MRI/MRA scans
• PET scans
• Nuclear cardiology studies

Prior plan approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient stay), mobile unit, urgent care center or ambulatory surgical center.

Prior plan approval is not needed for “low-tech�? procedures such as X-rays and mammograms. To learn if your plan requires prior plan approval for these services, review the diagnostic imaging section of your policy documentation.

CT scan: Computed tomography (CT) scan uses x-ray imaging to make detailed pictures of structures inside of the body.

CTA scan:Computed tomography angiogram (CTA) scan uses x-ray imaging to make detailed pictures of blood vessels inside the body. It is a type of computed tomography (CT) scan.

MRI scan: Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.

MRA scan:A magnetic resonance angiogram (MRA) uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. It is a type of magnetic resonance imaging (MRI) scan.

PET scan: Positron emission tomography (PET) is a test that uses a special type of camera and special nuclear medicine to look at organs in the body.

Prior plan approval is not required for diagnostic imaging procedures in emergency or urgent care situations (meaning the absence of medical attention could jeopardize the patient’s life, health or ability to regain maximum function) or when they are performed in an emergency room, hospital (related to an inpatient or observation stay), mobile unit, urgent care center or ambulatory surgical center.