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RADIOLOGY
UPDATE
Regulatory Updates

Effective November 16th, 2018 eviCore will no longer manage high-tech Radiology UM services. Certain imaging services will still require prior-approval, but these services will now be reviewed and managed directly by MetroPlus. Effective November 16, 2018, MetroPlus will require notification and authorization for the following high-tech radiology services:

PET Imaging CPT Codes that continue to require Prior Authorization:
78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816
MRI CPT Codes that continue to require Prior Authorization, following an initial spinal MRI within past 12 months:
72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159

Multiple high-tech imaging services performed on the same day and on the same organ system will require authorization. High-tech imaging is defined as MRI, MRA, PET and CT.

Source

INTEGRA PARTNERS WILL MANAGE DME UTILIZATION FOR METROPLUS MEMBERS

Effective December 1st, 2018 the following changes will take effect:

All prior authorization requests for DME services, excluding FIDA and MLTC, will be managed through Integra. Instructions on how to request prior authorization can be found on Integra’s website, www.accessintegra.com, under Resources/Forms and Training. For all claims with dates of service 12/01/18 and after.

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Insights
November 2018