The UnitedHealthcare Radiology Notification Program was designed with the help of external expert physician advisory groups to promote appropriate and rational use of imaging services. In addition, we have received meaningful input from physician organizations and network participants to design a program that minimizes physician inconvenience and respects the autonomy of the patient-physician relationship.
We emphasize that this is a prior notification program and not a precertification, preauthorization, or medical necessity determination. Advanced diagnostic imaging services that take place in an emergency room, observation unit or during an inpatient stay do not require notification.
Prior notification will be required for the following defined set of outpatient imaging procedures: CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology. See CPT code list below for the specific CPT codes included in the program.
Physicians who have received the UnitedHealth Premium® Quality and Efficiency of care designation are exempt from the Radiology Notification Program, in recognition of their demonstration of adherence to nationally recognized evidence-based quality and efficiency of care standards. At this time, some medical specialties are not evaluated for designation. In addition, the designation program has not been rolled out in some states. Visit the UnitedHealth Premium page to determine your designation status, or the status of another physician. Physicians receiving the UnitedHealth Premium Quality and Efficiency of Care designation are identified with two stars next to their names.
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