SOCal Auth guidelines

Auth requirements:

Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT

Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.  

Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

COMMONLY MISCHEDULED PROCEDURES

Irvine and Laguna Hills we are contracted with CalOptima effective 10/1/2021

Irvine and Laguna Hills NOT contracted with IEHP 

Kaiser patients only contracted with:  

• Beverly Hills (Standup)

• Riverside (OPEN)

PRECISE IMAGING IS A COMPANY ACCOUNT NOT WC/LIEN 

• 23357(Precise Imaging Tech Only-CA (SoCal Only)- USE FOR SCANS CONTAINING NO CONTRAST

• 23356 (Precise Imaging Global- CA(SoCal Only)- USE FOR ARTHROGRAMS AND X-RAY MRI CLEARANCE EXAMS 

NPI: 1104321959   TIN: 943292479