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.
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.
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
- CPT 75580 Addendum to Cardiology & Radiology Clinical Guidelines - Effective 05.01.2024
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 10.21.2024
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 08.19.2024
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 04.01.2024
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2024
- Community Plan Cardiovascular and Radiology Imaging Guidelines - Effective 09.15.2023
- UnitedHealthcare Community Plan Radiology Prior Authorization CPT Code List
- UnitedHealthcare Radiology Notification / Prior Authorization Crosswalk Table
- UnitedHealthcare Community Plan Radiology Prior Authorization Frequently Asked Questions
- UnitedHealthcare Community Plan Radiology Prior Authorization Quick Reference Guide
Maryland-Specific Radiology Resources
2024
Effective November 15, 2024
- UN-CSRAD001OH.C - Adult Abdomen Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD002OH.C - Adult Breast Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD003OH.C - Adult Cardiac Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD005OH.C - Adult Chest Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD006OH.C - Adult Head Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD007OH.C - Adult Musculoskeletal Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD008OH.C - Adult Neck Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD010OH.C - Adult Oncology Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD011OH.C - Adult Pelvis Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD012OH.C - Adult Peripheral Nerve Disorders (PND) Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD013OH.C - Adult Peripheral Vascular Disease (PVD) Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD014OH.C - Adult Spine Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD015OH.C - Pediatric Abdomen Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD016OH.C - Pediatric Cardiac Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD017OH.C - Pediatric Chest Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD018OH.C - Pediatric Head Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD019OH.C - Pediatric Musculoskeletal Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD020OH.C - Pediatric Neck Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD021OH.C - Pediatric Oncology Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD022OH.C - Pediatric Pelvis Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD023OH.C - Pediatric PND Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD024OH.C - Pediatric PVD Imaging Guidelines - Effective 11.15.2024
- UN-CSRAD025OH.C - Pediatric Spine Imaging Guidelines - Effective 11.15.2024
Effective February 1, 2024
- UN-CSRAD001OH.B - Adult Abdomen Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD002OH.B - Adult Breast Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD003OH.B - Adult Cardiac Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD005OH.B - Adult Chest Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD006OH.B - Adult Head Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD007OH.B - Adult Musculoskeletal Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD008OH.B - Adult Neck Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD010OH.B - Adult Oncology Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD011OH.B - Adult Pelvis Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD012OH.B - Adult Peripheral Nerve Disorders (PND) Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD013OH.B - Adult Peripheral Vascular Disease (PVD) Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD014OH.B - Adult Spine Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD015OH.B - Pediatric Abdomen Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD016OH.B - Pediatric Cardiac Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD017OH.B - Pediatric Chest Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD018OH.B - Pediatric Head Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD019OH.B - Pediatric Musculoskeletal Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD020OH.B - Pediatric Neck Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD021OH.B - Pediatric Oncology Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD022OH.B - Pediatric Pelvis Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD023OH.B - Pediatric PND Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD024OH.B - Pediatric PVD Imaging Guidelines - Effective 02.01.2024
- UN-CSRAD025OH.B - Pediatric Spine Imaging Guidelines - Effective 02.01.2024
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
- CPT 75580 Addendum to Cardiology & Radiology Clinical Guidelines - Effective 05.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 10.21.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 08.19.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 09.15.2023
- Commercial and Exchange Plans Radiology Prior Authorization Frequently Asked Questions
- Commercial and Exchange Plans Radiology Prior Authorization Quick Reference Guide
- Site of Service Reviews for MRI/CT Services - Frequently Asked Questions
- UnitedHealthcare Radiology Notification / Prior Authorization CPT Code List
- UnitedHealthcare Radiology Notification / Prior Authorization Crosswalk Table
- CPT 75580 Addendum to Cardiology & Radiology Clinical Guidelines - Effective 05.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 10.21.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 08.19.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2024
- Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 09.15.2023
- Commercial and Exchange Plans Radiology Prior Authorization Frequently Asked Questions
- Commercial and Exchange Plans Radiology Prior Authorization Quick Reference Guide
- MRI/CT Site of Service Reviews for Individual and Family Exchange Plans Frequently Asked Questions
- Additional resource materials are included in the Commercial section above
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 10.21.2024
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 08.19.2024
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 04.01.2024
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2024
- Medicare Advantage Cardiovascular and Radiology Imaging Guidelines - Effective 09.15.2023
- UnitedHealthcare Medicare Advantage Radiology Prior Authorization CPT Code List
- UnitedHealthcare Medicare Advantage Radiology Prior Authorization Crosswalk Table
- UnitedHealthcare Medicare Advantage Radiology Prior Authorization Frequently Asked Questions
- UnitedHealthcare Medicare Advantage Radiology Prior Authorization Quick Reference Guide
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:
- UnitedHealthcare Oxford CPT 75580 Addendum to Cardiology & Radiology Imaging Guidelines - Effective 05.01.2024
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines - Effective 10.21.2024
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines - Effective 08.19.2024
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines – Effective 04.01.2024
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines – Effective 03.01.2024
- UnitedHealthcare Oxford Cardiovascular and Radiology Imaging Guidelines – Effective 09.15.2023
- Accreditation Requirements for Radiology Services – Oxford Administrative Policy
- Breast Imaging for Screening and Diagnosing Cancer – Oxford Clinical Policy
- Credentialing Guidelines: Participation in the eviCore healthcare Network – Oxford Administrative Policy
- Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service – Oxford Clinical Policy
- Obstetrical Ultrasonography – Oxford Clinical Policy
- Oxford's Outpatient Imaging Self-Referral Policy – Oxford Clinical Policy
- Radiology Procedures for eviCore healthcare Arrangement – Oxford Clinical Policy
- Radiopharmaceuticals and Contrast Media – Oxford Clinical Policy
- UnitedHealthcare Oxford Radiology and Cardiology Prior Authorization Crosswalk Table