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Update to codes requiring prior authorization

Effective August 30, 2021, PacificSource will require prior authorization for the following codes related to Optical Coherence Tomography for Cardiac CPT/HCPC:

  • 92978 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT); initial vessel
  • 92979 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT); each additional vessel
  • C1753 Catheter, intravascular ultrasound
  • 37252 Intravascular ultrasound during diagnostic evaluation and/or therapeutic intervention, including radiological supercision and interpretation; initial noncoronary vessel
  • 37253 Intravascular ultrasound noncoronary RS&I additional vessel

 

Effective August 16, 2021, PacificSource will require prior authorization for the following codes:

  • 61791 Creation, lesion, stereotactic, percutaneous, neurolytic agent; trigeminal medullary tract
  • 77399 Unlisted proc, radiation/physics/dosimetry & treatment devices & special services
  • 77469 Intraoperative radiation treatment management
  • 77499 Unlisted proc, therapeutic radiology treatment management