Radiology and Cardiology Code List

eviCore healthcare helps to ensure that our members enrolled in Horizon NJ Medicaid and FIDE-SNP plans receive appropriate radiology/imaging services by performing Prior Authorization/Medical Necessity Determination reviews of the procedure codes listed below. Click a code category below or scroll down to review codes included as part of this program.

Cardiac codes
Cardiac MRI codes
Cardiac CT codes
CT codes
CTA codes
Echocardiogram codes
MRA codes
MRI codes
Nuclear Cardiac Imaging codes
Nuclear Medicine codes
PET Scans codes
Unlisted Codes

Recent/Upcoming Changes:

  • For services to be provided on and after July 1, 2022, eviCore will no longer perform PA/MND of the services represented by procedure codes 33214, 33221, 33225, 33227, 33228, 33229, 33230, 33231, 33240, 33249, 33262, 33263, 33264 and 33270. These and other cardiac-related services will be reviewed by TurningPoint Healthcare as part of our Surgical and Implantable Device Management Program for Cardiac Services.
  • For services to be provided on and after January 19, 2022, eviCore will also perform PA/MND of the services represented by procedure codes 0697T, 0698T, 0710T, 0711T, 0712T, 0713T and 93319.

Notes:

  • The services represented by procedure codes 0710T, 0711T, 0712T, and 0713T are experimental & investigational.
  • Coding Note: C-Codes are for facility/hospital use only (only for UB04 claims submission).

This listing was last revised on April 14, 2022 and may be subject to change.

0614T
33214
33221
33224
33225
33227
33228
33229
33230
33231
33240
33249
33262
33263
33264
33270
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93462
75557
75559
75561
75563
C9762
C9763
0501T
0502T
0503T
0504T
75571
75572
75573
75574
0042T
0633T
0634T
0635T
0636T
0638T
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
71250
71260
71270
71271
72125
72126
72127
72128
72129
72130
72131
72132
72133
72192
72193
72194
73200
73201
73202
73700
73701
73702
74150
74160
74170
74176
74177
74178
74261
74262
74263
76376
76377
76380
77078
78205
78206
78607
78647
78710
78805
78806
78807
G0297
70496
70498
71275
72191
73206
73706
74174
74175
75635
93303
93304
93306
93307
93308
93312
93313
93314
93315
93316
93317
93350
93351
93319
C8921
C8922
C8923
C8924
C8925
C8926
C8928
C8929
C8930
70544
70545
70546
70547
70548
70549
71555
72159
72198
73225
73725
74185
C8900
C8901
C8902
C8909
C8910
C8911
C8912
C8913
C8914
C8918
C8919
C8920
C8931
C8932
C8933
C8934
C8935
C8936
0609T
0610T
0611T
0612T
0623T
0624T
0625T
0626T
0648T
0649T
0697T
0698T
0710T
0711T
0712T
0713T
70336
70540
70542
70543
70551
70552
70553
70554
70555
71550
71551
71552
72141
72142
72146
72147
72148
72149
72156
72157
72158
72195
72196
72197
73218
73219
73220
73221
73222
73223
73718
73719
73720
73721
73722
73723
74181
74182
74183
74712
74713
76390
76391
77021
77022
77046
77047
77048
77049
77084
C8903
C8905
C8906
C8908
S8037
S8042
78414
78428
78445
78451
78452
78453
78454
78456
78457
78458
78466
78468
78469
78472
78473
78481
78483
78494
78496
78012
78013
78014
78015
78016
78018
78020
78070
78071
78072
78075
78102
78103
78104
78185
78195
78201
78202
78215
78216
78226
78227
78230
78231
78232
78258
78261
78262
78264
78265
78266
78278
78290
78291
78300
78305
78306
78315
78579
78580
78582
78597
78598
78600
78601
78605
78606
78610
78630
78635
78645
78650
78660
78700
78701
78707
78708
78709
78725
78730
78740
78761
78800
78801
78802
78803
78804
78830
78831
78832
78429
78430
78431
78432
78433
78434
78459
78491
78492
78608
78609
78811
78812
78813
78814
78815
78816
G0219
G0235
G0252
S8085
76497
76498
78499
78699
78999

CPT® is a registered trademark of the American Medical Association

eviCore healthcare is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the provision of Prior Authorization and/or Medical Necessity Review (PA/MND) of certain nonemergency radiology services.