Correction to CPT Codes for CT and PET Scans, CR 38797

February 21, 2014

In a listserv on February 7, 2014, we published a CPT code that is not covered by MaineCare. CPT code 74263 is not covered by MaineCare.

Below, is a corrected listserv:

Accepting PA Requests for CT and PET Scans, CR 38797

Effective February 5, 2014, the Health PAS Online Portal has been updated to accept Prior Authorization (PA) requests for some CT and PET Scans. Providers are required to obtain a PA for these CT and PET scans for dates of service on or after March 1, 2014. The complete list of CPT codes is at the bottom of this message.

The following details are provided as part of this change:

  • The portal is enhanced to allow PA requests for certain CT and PET scans, as well as to provide an immediate response to your PA request. This response will include an auto approval or a pending status immediately after submitting.

  • 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 guide is posted to the portal which gives providers instructions regarding the portal enhancements and can be found in the Authorizations Pathways folder.

  • If a request is set to a pend status, please upload a copy of the Radiology Supplement form titled “P.A. Request Form – Pathways Radiology”

    • Uploaded Radiology Supplement forms do not need to have the members’ demographic section completed since the upload will link to the PA request. See section 16 of the Pathways Radiology PA Request Guide.

    • If you are having trouble getting the document to upload, please call Provider Services at 1-866-690-5585.

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, 75571, 75572, 75573, 75574, 75635, 76376, 76377, 76380, 77078, 92025, 78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816