Medical Necessity & CPT Codes
Appropriateness codes support insurance coverage.
Following the guidelines below can enhance care quality, promote the effective use of radiology and reduce overall healthcare costs. Insurance providers require that radiology exams include medical necessity information as well as appropriate CPT codes. Without a covered diagnosis, your patient – not the insurer – will pay for imaging services. Adding medical necessity information benefits your patient.
Avoid Making These Common Mistakes When Ordering Radiology Exams
- Diagnosis or working symptoms – It’s important that our radiologists understand a patient’s clinical conditions to ensure that appropriate imaging is being performed. Do not order “rule out” exams unless a patient’s history and symptoms are fully detailed.
- Valid Signature – Legible handwritten or valid electronic signatures are the only types of signatures we accept. Stamped signatures are not considered valid.
- Exam description or CPT code – Provider notes aid in ensuring the correct exam is being performed. Resources for clinical decision support include our radiologists and the ACR Appropriateness criteria guide.
- Comparison Studies – Let us know if there are prior studies that can be used for comparison.
Resources for Meeting Medical Necessity