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Prior Authorization – Radiology Services

Patients being seen in the office setting often present with symptoms that can be difficult to diagnose on examination alone: cholecystitis vs gastritis; diverticulitis vs constipation; pulmonary embolism vs acid reflux; deep vein thrombosis vs. musculoskeletal calf pain.

As is often the case, the key to an accurate diagnosis is based on performing the correct diagnostic studies during the most critical window of opportunity. HCP is here to help.

Through a partnership with the two leading freestanding imaging organizations in NYC and LI, Zwanger-Pesiri and RadNet, which together comprise a large network of outpatient imaging centers that can bring real-time diagnostics to the busy Primary Care Practitioner.

In addition to being able to obtain plain films without Prior Authorization in the office setting or at a freestanding imaging center, both Zwanger-Pesiri and RadNet facilities will provide additional imaging services with no PA required.

  • CT of Head without contrast (CPT 70450)
  • CT of Abdomen and Pelvis without contrast (CPT 74176)
  • CT of Abdomen and Pelvis with contrast (CPT 74177)
  • CT of Abdomen and Pelvis with/without contrast (CPT 74178)
  • CT Angiography of Chest (non-coronary) (CPT 71275)
  • MRI of Brain without contrast (only when ordered by a neurologist) (CPT 70551)

Your patient can be sent directly to one of Zwanger-Pesiri’s or RadNet’s free-standing facilities to have the study done. A radiologist will quickly call you with the interpretation of the study. This will allow you to manage time-sensitive clinical conditions while avoiding unnecessary trips to the Emergency Department.

At present, these additional services are only available to EmblemHealth patients whose PCP has a direct contract with HCP. For Emblem Health Cohort 2 patients (with no direct HCP contract), you must contact eviCore for high-tech imaging and cardiac imaging requests. EmpireBCBS Medicare patients must utilize the services of AIM for imaging prior authorizations.

For additional assistance with urgent imaging (or other time-sensitive clinical needs) you can also contact the HCP RTR™ line.

Obtaining Radiology Services

The following radiology services can be obtained without Prior Authorization:

  1. All plain film studies performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.
  2. All ultrasound studies of the abdomen and lower extremities performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.
  3. All studies associated with provision of emergency care.
  4. CT Head without contrast, CT Abdomen and Pelvis without contrast, CT Angiography of chest (non-cardiac), and MRI brain without contrast (MRI brain must be ordered by a neurologist to avoid PA requirements), all when medically necessary.
  5. Preventative care imaging studies, e.g. Mammography.

All other services require Prior Authorization.

A request for Prior Authorization can be submitted to HCP in one of two ways:

  1. The preferred and most efficient way to submit a Prior Authorization (PA) request is via the HCP Web-based data interface, EZ-Net.

    Login credentials for EZ-Net are required. Learn More about EZ-Net.

  2. Prior Authorization requests may also be submitted via FAX.

Send a completed Authorization Request form to (888) 746-6433 or (516) 746-6433.