Diagnostic Imaging CPT Codes That Require Certification
Posted 06/19/12

Certification is a medical review process performed to establish medical necessity for certain services.  Certification for diagnostic imaging services is performed by the HealthChoice certification administrator, APS Healthcare.

Currently, the following diagnostic imaging procedures require certification through APS Healthcare:

• Sinus CT and MRI 
• Spine CT and MRI 
• Orbit and Ear CT and MRI
• Head/Brain CT and MRI
• Upper Extremity MRI
• Chest CT including Spiral CT (RAD)
• PET Scans

Following is a list of CPT Codes for the procedures listed above:

Providers can contact APS Healthcare toll-free at 1-800-848-8121 and use the VoiCert automated phone system to request certifications. Call APS and follow the telephone prompts to leave certification requests through VoiCert.

If you have questions about certification, please contact APS Healthcare toll-free at 1-800-848-8121, or contact the HealthChoice Health Care Management Division 1-405-717-8879 or toll-free 1-800-543-6044. ext.  8879.

Note: CPT/HCPCS codes are subject to change because of code additions, deletions, and changes as determined by the American Medical Association (AMA) and adopted by OSEEGIB.