Medicare AdvantagePrior AuthMedium impact
MA09.002ae, High-Technology Radiology Services
Independence Blue Cross·Radiology, Nuclear Medicine, Cardiology·Medical Policy
Effective date
Nov 15, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA09.002ae to MA09.002ai, adding CPT codes 95965 and 95966 to the high-technology radiology services subject to Carelon Medical Benefits Management utilization management. The policy delegates pre-authorization requirements for advanced imaging to Carelon, with updated clinical appropriateness guidelines effective 11/15/2025.
Action Required
By November 15, 2025: Billing team must update billing system to route CPT codes 95965 and 95966 through Carelon Medical Benefits Management for prior authorization review before claim submission. Verify that these codes now require medical necessity review per Carelon's Advanced Imaging Clinical Appropriateness Guidelines. Update provider ordering systems and templates to alert providers that these codes require pre-authorization. Note: These requirements do NOT apply to services performed in emergency rooms or during inpatient/observation stays. Claims submitted without proper authorization will be subject to denial.