Effective August 30, 2021, PacificSource will require prior authorization for the following codes related to Optical Coherence Tomography for Cardiac CPT/HCPC:
- 92978 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT); initial vessel
- 92979 Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT); each additional vessel
- C1753 Catheter, intravascular ultrasound
- 37252 Intravascular ultrasound during diagnostic evaluation and/or therapeutic intervention, including radiological supercision and interpretation; initial noncoronary vessel
- 37253 Intravascular ultrasound noncoronary RS&I additional vessel
Effective August 16, 2021, PacificSource will require prior authorization for the following codes:
- 61791 Creation, lesion, stereotactic, percutaneous, neurolytic agent; trigeminal medullary tract
- 77399 Unlisted proc, radiation/physics/dosimetry & treatment devices & special services
- 77469 Intraoperative radiation treatment management
- 77499 Unlisted proc, therapeutic radiology treatment management