Prior authorization for stress echocardiography—which Highmark had previously announced would be required Sept. 1, 2010—will no longer be required. Beginning Sept. 1, only prior notification will be required before a test is performed.
Prior authorization will still be required for myocardial perfusion imaging and nuclear cardiology services beginning Sept. 1.
When performing a stress echocardiogram, physicians will have to notify National Imaging Associates (NIA), a radiology management firm contracted by Highmark, before performing a service. NIA will not deny the test and will not suggest any substitute tests. This applies to outpatient, non-emergency imaging procedures with the billing codes 93350-93352.
For myocardial perfusion imaging and nuclear cardiology services, prior authorization must be obtained through NIA, which will approve or deny the service and may suggest alternative testing. Prior authorization applies to codes 78451-78454, 78466, 78468, 78469, 78481, 78483, 78484, and 78499.
These policies apply to patients enrolled in DirectBlue, PPOBlue, FreedomBlue PPO, EPOBlue, and PPOPlus plans.
Physicians should use NaviNet for both prior authorization requests and prior notifications. If you don’t have NaviNet, call (866) 731-8080, select option four, and request authorizations.
For more information, call your Highmark provider relations representative or visit Highmark’s website.