Your plan for better healthSM1

Diagnostic imaging management program

Prior review/prior approval is now required for high-tech diagnostic imaging services listed below when performed in a physician's office, the outpatient department of a hospital, or a freestanding imaging center on or after February 15, 2007.1 Prior approval for these services for Blue Medicare HMO and Blue Medicare PPO members will be required as of September 1, 2010.

  • CT/CTA scans
  • MRI/MRA scans
  • Nuclear cardiology studies
  • PET scans
  • Echocardiography

Ordering physicians for BCBSNC members must contact AIM to obtain prior review/prior approval (also known as prior authorization) before scheduling an imaging exam for the outpatient diagnostic, non-emergency services listed above.

Servicing providers (hospitals and freestanding imaging centers) should confirm that prior review/prior approval was issued prior to performing the service. Issuance of prior review/prior approval is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of the patient's health benefit plan. Only ordering physicians can obtain prior review/prior approval. Hospitals and freestanding imaging centers that perform the imaging services listed cannot obtain prior review/prior approval.

The diagnostic imaging management process is based upon AIM's clinical practice guidelines. They are developed from consensus opinion in medical practice and integration of medical information from multiple sources. These sources include:

  • American College of Radiology (ACR) Appropriateness Criteria
  • American Institute of Ultrasound in Medicine (AIUM)
  • Society of Nuclear Medicine (SNM)
  • American Academy of Neurology (AAN)
  • American College of Cardiology (ACC)
  • American Heart Association (AHA)
  • American Medical Association (AMA)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Centers for Medicare and Medicaid Services (CMS) National and Local Coverage Determinations

The documents below include detailed information about the program and checklists to help office staff understand and efficiently utilize the prior review/prior approval process for diagnostic imaging.

Diagnostic Imaging Provider Training (3.6MB) 

DIM Servicing Provider Quick Reference Guide (356KB) 

DIM Ordering Provider Quick Reference Guide (347KB) 

For more information about the Diagnostic Imaging Management program and how you can request prior review/prior approval for dates of service on or after February 15, 2007, please visit the Diagnostic Imaging Procedures page.

1 Prior review/prior approval is not required when services are performed in an emergency room, hospital (related to an inpatient stay), urgent care center or ambulatory surgical center.