Provider Manual

Chapter 20: Radiology Privileging

In this chapter you will find radiology privileging protocols to improve quality of care and make imaging services available when rendered by physicians other than radiologists.

 

 

There are many clinical reasons physicians other than radiologists must perform in-office imaging as part of their diagnostic and treatment plans. We have radiology privileging protocols to make imaging services available when rendered by physicians other than radiologists.

 

This chapter includes the lists of procedures and associated CPT-4 codes that network physicians other than radiologists can perform for specific benefit plans based on their specialty and network participation.

 

This program applies to members with the following benefit plans and to practitioners who service these members:

  • EmblemHealth EPO/PPO
  • GHI
  • Vytra

 

Note: GHI HMO members and practitioners are not eligible for this program. Protocols for HIP, EmblemHealth CompreHealth EPO and EmblemHealth Medicare HMO appear in the HIP Outpatient Diagnostic Imaging Self-Referral Payment Policy chapter.

 

For physicians to perform radiological procedures within their specialty, they must have the appropriate certifications or accreditations, as noted in the Radiology Privileging by Specialty charts in this chapter. Certain procedures require prior approval. When radiological procedures are performed outside the physician’s specialty or when appropriate prior approval is not obtained, claims for such services will be denied, with no liability to the member.

 

The charts below detail the inpatient, outpatient and office-based radiology services for which reimbursement will be made when performed by physicians other than radiologists.

  • GHI and EmblemHealth EPO/PPO Practitioners
  • Vytra Practitioners

 

GHI and EmblemHealth EPO/PPO Radiology Privileging By Specialty
PHYSICIAN TYPE CPT-4 CODE CPT-4 DESCRIPTION

Primary Care Physicians (includes Internal Medicine, Family Practice, General Practice MD, General Practice DO, Geriatrics, Preventive Medicine, Screening Center)

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

Allergists

74000-74022

Abdomen Imaging

77080, 77081

DEXA Studies, Bone Densitometry

Chiropractors

72010, 72040, 72069, 72070, 72080, 72100

Spine Imaging

Dermatologists

77401

Radiation Treatment Delivery

Emergency Medicine

74000-74022

Abdomen Imaging

77080, 77081

DEXA Studies, Bone Densitometry

Endocrinologists

77080, 77081

DEXA Studies, Bone Densitometry

76942

Ultrasonic Guidance

76536

Thyroid Ultrasound

71010-71023

Chest Imaging

74000-74022

Abdomen Imaging

Gastroenterologists

76975

Endoscopic Ultrasound

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

Gynecological Oncology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

77057

Screening Mammography

77014

CT Guidance

76830, 76856, 76857

Nonobstetrical Ultrasounds, Pelvis

76873

Ultrasound, Transrectal

76930, 76941, 76945, 76946, 76950

Ultrasonic Guidance

Gynecology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

77057

Screening Mammography

77014

CT Guidance

76830, 76856, 76857

Non-Obstetrical Ultrasounds, Pelvis

76930, 76941, 76945, 76946

Ultrasonic Guidance

Hand Surgeons

73090-73140

Upper Extremity Imaging

76000-76010

Fluoroscopy

77073

Bone Length Study

77077

Joint Survey

77080, 77081

DEXA Studies, Bone Densitometry

Hematology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

Infectious Disease

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

Neonatology/Perinatology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

76506, 76511-76529

Echoencephalography

76604, 76645

Chest Ultrasound

76801-76812, 76815-76819, 76825-76828

Obstetrical Ultrasounds, Pelvis

76830-76857

Nonobstetrical Ultrasounds, Pelvis

76930-76946

Ultrasonic Guidance

Nephrology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

76770, 76775

Retroperitoneal Ultrasound

Neurology

71010-71030

Chest Imaging

74000-74022

Abdomen Imaging

70010-70553, 70557-70559

Head/Neck Imaging

72010-72120

Spine Imaging

Obstetrics and Gynecology 

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

77057

Screening Mammography

76801-76812, 76815-76819, 76825-76828

Obstetrical Ultrasounds, Pelvis

76830, 76856, 76857

Nonobstetrical Ultrasounds, Pelvis

76930, 76941, 76945, 76946

Ultrasonic Guidance

Oncology

71010-71023

Chest Imaging

77080, 77081

DEXA Studies, Bone Densitometry

74000-74022

Abdomen Imaging

77014

CT Guidance

76873

Ultrasound, Transrectal

76950

Ultrasonic Guidance

Ophthalmologists and Optometrists

77014

CT Guidance

76506, 76511-76529

Ophthalmic Ultrasound

Oral Surgeons

70100, 70110, 70140, 70150

Mandible/Facial Bone Imaging

70300, 70310, 70320

Teeth Imaging

70350

Cephalogram

70355

Orthopantogram

Otolaryngologists

70010, 70015, 70030-70220, 70140, 70250-70320, 70332, 70336*, 70350, 70355, 70360, 70370, 70371, 70373, 70380, 70390, 70496*

Head/Neck Imaging

Pediatrics

71010-71023

Chest Imaging

74000-74022

Abdomen Imaging

Perinatology

74000-74022

Abdomen Imaging

77080, 77081

DEXA Studies, Bone Densitometry

77057

Screening Mammography

76604, 76645

Chest Ultrasound

76801-76812, 76815-76819, 76825-76828

Obstetrical Ultrasounds, Pelvis

76830, 76831, 76856, 76857

Nonobstetrical Ultrasounds, Pelvis

76930, 76932, 76936, 76937, 76940, 76941, 76945, 76946

Ultrasonic Guidance

Physical Medicine and Rehabilitation

70360-70390

Head/Neck Imaging

72010-72120, 72170, 72190, 72200-72220

Spine/Pelvis Imaging

73000-73140

Upper Extremities Imaging

73500-73660

Lower Extremities Imaging

74000-74022

Abdomen Imaging

Podiatrists, Podiatric Surgeons, Podiatric Orthopedists

73600, 73610, 73620, 73630, 73650, 73660

Lower Extremities Imaging

Pulmonologists

71010-71023

Chest Imaging

74000-74022

Abdomen Imaging

77080, 77081

DEXA Studies, Bone Densitometry

76700-76775

Ultrasound Abdomen/Retroperitoneum

Reproductive Endocrinologists

71010-71023

Chest Imaging

74000-74022

Abdomen Imaging

77080, 77081

DEXA Studies, Bone Densitometry

76801-76812, 76818, 76819, 76825-76828

Obstetrical Ultrasounds, Pelvis

76830-76857

Nonobstetrical Ultrasounds, Pelvis

76930-76941, 76945-76948

Ultrasonic Guidance

Rheumatologists

71010-71030

Chest Imaging

72010-72120, 72170, 72190, 72200-72285, 72291

Spine/Pelvis Imaging

73000-73140

Upper Extremities Imaging

73500-73660

Lower Extremities Imaging

74000-74022

Abdomen Imaging

76000, 76001, 76010, 77002, 77003

Fluoroscopic Guidance

77071, 77072, 77073

Bone/Joint Studies

77077

Joint Survey

Urologists

74000-74022

Abdomen Imaging

74400, 74425, 74430, 74450, 74455

Ultrasound, Urinary Tract

76000

Fluoroscopy

76870, 76872, 76873

Ultrasound Genitalia

76942

Ultrasonic Guidance

*These procedures require prior approval.

 

 

Vytra Radiology Privileging By Specialty
PHYSICIAN TYPE CPT-4 CODE CPT-4 DESCRIPTION

Cardiology

78414-78499

Cardiac Nuclear Medicine Studies

General Surgery

76942

Echo Guide for Biopsy

76942

Ultrasonic Guidance

Gynecology

76830

Transvaginal Ultrasound

76998

Ultrasonic Guidance

74740

Hysterosalpingography

Hand Surgery
(practitioner must be certified in Hand Surgery by the American Board of Medical Specialties)

Those radiology procedures within the scope of the specialty area

Obstetrics and 
Gynecology

76805-76831

Pregnancy-Related Sonograms

76856

Pelvic Ultrasound, Nonobstetrical

76941-76946

Needle Guidance Sonograms Used for Amniocentesis

76998

Ultrasonic Guidance

Oncology

71010, 71020

Chest X-rays

Orthopedics

Those radiology procedures within the scope of the specialty area

Pulmonology

71010, 71020

Chest X-rays

Rheumatology

Those radiology procedures within the scope of the specialty area

Urology

76942, 76872, 76950, 77778, 78730

Ultrasound Guidance for Needle Biopsy

 

Vytra reviews this list on an ongoing basis and revises it as appropriate.