Prior Authorizations (PA) for CT and PET Scans, CR 38797

January 24, 2014

MaineCare will have new requirements regarding some CT and PET scans requiring a Prior Authorization. The complete list of CPT codes is at the bottom of this message. Providers will be required to obtain a PA for these CT and PET scans for dates of service on or after March 1, 2014. The Health PAS Online Portal will be updated to accept PA requests beginning in February 2014.

We will send additional information to you via listserv message prior to February 2014. The following details are provided in preparation for this change.

  • The Provider portal will be enhanced to allow PA requests for certain CT and PET scans as well as obtain an immediate response to your PA request. This response will include an auto approval or a pending status immediately after submitting. We anticipate the enhancement to allow a PA request for the scans to be available on the portal on February 3, 2014 in order to accept PA requests for future dates of service.

  • PAs will be required for CT and PET scans rendered to MaineCare members ages 21- 64, for services on or after March 1, 2014.

  • A provider guide will be posted to the portal to provide instructions regarding the portal enhancements prior to implementation.

List of CPT Codes:

  • 70450

  • 70460

  • 70470

  • 70480

  • 70481

  • 70482

  • 70486

  • 70487

  • 70488

  • 70490

  • 70491

  • 70492

  • 70496

  • 70498

  • 71250

  • 71260

  • 71270

  • 71275

  • 72125

  • 72126

  • 72127

  • 72128

  • 72129

  • 72130

  • 72131

  • 72132

  • 72133

  • 72191

  • 72192

  • 72193

  • 72194

  • 72292

  • 73200

  • 73201

  • 73202

  • 73206

  • 73700

  • 73701

  • 73702

  • 73706

  • 74150

  • 74160

  • 74170

  • 74174

  • 74175

  • 74176

  • 74177

  • 74178

  • 74261

  • 74262

  • 74263

  • 75571

  • 75572

  • 75573

  • 75574

  • 75635

  • 76376

  • 76377

  • 76380

  • 77078

  • 92025

  • 78459

  • 78491

  • 78492

  • 78608

  • 78609

  • 78811

  • 78812

  • 78813

  • 78814

  • 78815

  • 78816