CommercialPrior AuthHigh impact
Outpatient Radiology Procedures for EviCore Arrangement (for Oxford Only)
UnitedHealthcare·Radiology, Nuclear Medicine, Cardiology·Medical Policy
Effective date
Nov 1, 2026
We identified it
Oct 3, 2026
Summary
Oxford has engaged EviCore to manage prior authorization for outpatient radiology procedures (MRI, CT, PET, nuclear medicine, ultrasound). Seven CPT/HCPCS codes have been removed from prior authorization requirements (0174T, 0175T, 76499, 78496, 78499, 78579, S8080). All remaining radiology prior authorizations must be requested through EviCore via phone (1-877-773-2884) or the Prior Authorization and Notification App, with authorization valid for 45 days.
Action Required
By November 1, 2026: (1) Billing team must update all billing system workflows to route Oxford commercial radiology prior authorization requests to EviCore instead of Oxford directly. (2) Remove CPT codes 0174T, 0175T, 76499, 78496, 78499, 78579, and S8080 from Oxford's prior authorization requirement list in billing software. (3) Update provider-facing templates and encounter forms to include EviCore contact information (1-877-773-2884) and Prior Authorization and Notification App instructions. (4) Train front desk and billing staff that only referring physicians can submit prior authorization requests to EviCore—requests from other entities will be rejected. (5) Update internal workflows to note that authorization numbers are valid for 45 calendar days and specific to one procedure date of service. (6) Facilities must verify their accreditation status (ACR, AIUM, IAC, RadSite, or TJC) and submit credentials directly to EviCore website. Failure to obtain proper EviCore prior authorization for covered radiology procedures will result in claim denials.