January 2020 ~

Effective January 1, UnitedHealthcare (UHC) will update the procedure code list for the Radiology Notification and Prior Authorization programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after January 1 are subject to these changes.

The following CPT^® codes are being added to the Radiology Notification and Prior Authorization list:

Code: 78830

Code Description: Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (e.g., head, neck, chest, pelvis), single day imaging

Comments: New code replacing 78805, 78806 or 78807 (78805, 78806 and 78807 are deleted codes as of Jan. 1, 2020)

Code: 78831

Code Description: Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum two areas (e.g., pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over two or more days

Comments: New code replacing 78805, 78806 or 78807 (78805, 78806 and 78807 are deleted codes as of Jan. 1, 2020)

Code: 78832

Code Description: Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum two areas (e.g., pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over two or more days

Comments: New code replacing 78805, 78806 or 78807 (78805, 78806 and 78807 are deleted codes as of Jan. 1, 2020)

The following CPT codes are being deleted from the Radiology Notification and Prior Authorization list.

Code: 78205

Code Description: Liver Imaging SPECT (3D)

Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020)

Code: 78206

Code Description: Liver Imaging SPECT With Vascular Flow

Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020)

Code: 78320

Code Description: Bone Joint Imaging Tomographic Test SPECT

Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020)

Code: 78607

Code Description: Brain Imaging 3D

Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020)

Code: 78647

Code Description: Cerebrospinal Fluid Scan (Tomographic) SPECT

Comments: Deleted code as of Jan. 1, 2020n(Use 78803 effective Jan. 1, 2020)

Code: 78710

Code Description: Kidney Imaging – Tomographic (SPECT)

Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020) 78805 Radiopharmaceutical Localization of Abscess, Limited Area Deleted code as of Jan. 1, 2020 (Select appropriate AMA code effective Jan. 1, 2020)

Code: 78806

Code Description: Radiopharmaceutical Localization of Abscess, Whole Body

Comments: Deleted code as of Jan. 1, 2020 (Select appropriate AMA code effective Jan. 1, 2020)

Code: 78807

Code Description: Radiopharmaceutical Localization of Abscess, Tomographic SPECT

Comments: Deleted code as of Jan. 1, 2020 (Select appropriate AMA code effective Jan. 1, 2020)

 

CPT^® is a registered trademark of the American Medical Association.

 

 

Source(s): January 2020 Network Bulletin – UnitedHealthcare;