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MA09.002ai, High-Technology Radiology Services
Effective date
Sep 19, 2026
Identified
Sep 20, 2026
Summary
Independence Blue Cross has delegated utilization management for high-technology radiology services (CT, MRI, PET, echocardiography, and others) to Carelon Medical Benefits Management effective 09/19/2026. Prior authorization determinations will follow Medicare guidelines (NCD/LCD) first, then Carelon's Advanced Imaging Clinical Appropriateness Guidelines if Medicare guidelines don't exist. Emergency room, inpatient, and observation unit services are excluded from this delegation.
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What to do
Action · 6 steps
01By 09/19/2026: Billing and clinical staff must implement the following changes.
02Obtain prior authorization from Carelon Medical Benefits Management (not Independence Blue Cross directly) for all high-technology radiology services performed in outpatient settings, including CT, CTA, MRI, PET, echocardiography, nuclear cardiology, and related services listed in Attachment A.
03Update billing software and EMR systems to route prior auth requests to Carelon instead of IBC.
04Train providers and billing staff that emergency department, inpatient, and observation unit radiology services are NOT subject to this new utilization management process.
05Access the updated Carelon Advanced Imaging Clinical Appropriateness Guidelines at https://guidelines.carelonmedicalbenefitsmanagement.com/current-radiology-guidelines/ and integrate medical necessity criteria into ordering workflows.
06Reference Attachment A of the policy for the complete list of affected CPT and HCPCS codes.
If missed: Failure to route prior auth requests to Carelon may result in delayed approvals, claim denials, or payment recoupment.
Original notice
MA09.002ai, High-Technology Radiology Services
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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