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Prior Authorization Requirements for Advanced Imaging Services Reminder in an Outpatient Hospital Setting pdf
Connecticut Medicaid (HUSKY Health)·CT · Radiology, Diagnostic Imaging·Prior Authorization
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
For advanced imaging services in outpatient hospital settings, ordering providers must request prior authorization using HCPCS 'C' codes instead of CPT codes. Outpatient hospitals must verify valid authorization exists for the appropriate 'C' code before performing services, or claims will be denied.
Action Required
Immediately: Ordering providers (physicians, APRNs, PAs, chiropractors, CNMs) must request prior authorization using HCPCS 'C' codes instead of CPT codes for advanced imaging in outpatient hospital settings. Outpatient hospitals must verify valid authorization exists for appropriate 'C' code before performing services. Reference Provider Bulletin 2016-70 for CPT to HCPCS 'C' code mapping. Contact CHNCT at 1-800-440-5071 if authorization on file lacks 'C' code to prevent claim denials.