Prior Authorization for Radiology Services
Patients often present in the office setting with symptoms that can be difficult to diagnose on examination alone: cholecystitis vs gastritis; diverticulitis vs constipation; pulmonary embolism vs acid reflux; deep vein thrombosis vs. musculoskeletal calf pain.
The key to an accurate diagnosis is based on performing the correct diagnostic studies during the most critical window of opportunity. HCP is here to help.
Zwanger-Pesiri and RadNet
Our partnership with Zwanger-Pesiri and RadNet, two leading freestanding imaging organizations in NYC and LI, can bring real-time diagnostics to the busy Primary Care Practitioner.
Your patient can be sent directly to one of Zwanger-Pesiri’s or RadNet’s free-standing facilities to complete the study. A radiologist will quickly call you with the interpretation of the study. This will allow you to manage time-sensitive clinical conditions while avoiding unnecessary visits to the Emergency Department.
At present, these additional services are only available to EmblemHealth patients whose PCP has a direct contract with HCP. Anthem BCBS Medicare patients must utilize the services of Carelon Medical Benefits Management for imaging prior authorizations.
For additional assistance with urgent imaging (or other time-sensitive clinical needs), you can also contact the HCP RTR™ line.
Radiology Services Without Prior Authorization
In addition to being able to obtain plain films without Prior Authorization in the office setting or at a freestanding imaging center, Zwanger-Pesiri and RadNet facilities will provide additional imaging services with no PA required.
The following radiology services can be obtained without Prior Authorization:
- CT of Head without contrast (CPT 70450)
- CT of Abdomen and Pelvis without contrast (CPT 74176)
- CT of Abdomen and Pelvis with contrast (CPT 74177)
- CT of Abdomen and Pelvis with/without contrast (CPT 74178)
- CT Angiography of Chest (non-coronary) (CPT 71275)
- MRI of Brain without contrast (only when ordered by a neurologist) (CPT 70551)
- All plain film studies performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.
- All ultrasound studies of the abdomen and lower extremities performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.
- All studies associated with the provision of emergency care.
- Preventative care imaging studies, e.g. Mammography.
All Other Services Require Prior Authorization
A request for Prior Authorization can be submitted to HCP in one of two ways:
EZ-Net is the preferred and most efficient way to submit a Prior Authorization (PA).
Login credentials for EZ-Net are required. Learn More about EZ-Net.
- Prior Authorization requests may also be submitted via FAX.
Send a completed Authorization Request form to (888) 746-6433 or (516) 746-6433.
