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Radiology Prior Authorization and Notification

These programs support the consistent use of evidence-based, professional guidelines for diagnostic imaging procedures. They help reduce risks to patients and improve the quality, safety and appropriate use of imaging procedures.

To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal.

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Basic Requirements and Process

Notification and prior authorization may be required for these advanced outpatient imaging procedures:

  • CT scans*
  • MRIs*
  • MRAs*
  • PET scans
  • Nuclear medicine studies, including nuclear cardiology

Authorization is not required for procedures performed in an emergency room, observation unit, urgent care center or during an inpatient stay.

*Note: For Medicare Advantage benefit plans, prior authorization is not required for CT, MRI, or MRA.

These requirements apply to all providers subject to the UnitedHealthcare Administrative Guide. To review the complete protocol, please refer to the Outpatient Radiology Notification/Prior Authorization Protocol section in that guide.

For further information on related imaging policies, see Imaging Accreditation.

Specific Radiology Programs

Open the section below to view more information.

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This program is effective in Arizona, Florida, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington and Wisconsin.

Community Plan Resources 

Maryland-Specific Radiology Resources 

2024

Effective November 15, 2024

Effective February 1, 2024

The following Commercial resource materials are inclusive of the UnitedHealthcare River Valley and NHP membership.

When you notify us of a planned service that is subject to the protocol, we’ll conduct a clinical review to determine if the service is medically necessary and covered, and will let you know our decision.

If the member's benefit plan does not require a clinical review and the service does not meet clinical guidelines, or if additional information is needed, we’ll let you know if you need to have a physician-to-physician discussion.

Commercial Resources 

These resources are available to care providers with members in M.D.IPA, M.D.IPA Preferred, Optimum Choice, Inc., and Optimum Choice Preferred health plans unless otherwise noted.

Resources materials are included in the Commercial tab above.

Resources materials are included in the Commercial tab above.

For information about UnitedHealthcare Oxford policies, please refer to the UnitedHealthcare® Oxford Clinical, Administrative and Reimbursement Policies page. This page has all UnitedHealthcare Oxford clinical, administrative and reimbursement policies, including the following commonly referenced clinical guidelines and imaging policies:

View Current Policies