Effective for dates of service on or after January 1, 2013, providers will need to obtain prior authorization for AmeriHealth 65 NJ HMO and AmeriHealth 65 Preferred HMO members for cardiac radiology services, which include:

• stress echocardiography
• resting transthoracic echocardiography
• transesophageal echocardiography

This policy does not apply to studies performed in the emergency room or during an inpatient or observation unit stay.

Specific CPT? codes to which the prior authorization applies are listed in the table below:

*Denotes a CPT code that is an add-on/secondary code to the primary code and does not require review through AIM Specialty Health, Inc.

This change is being made to align Medicare Advantage HMO prior authorization requirements to those already in place for AmeriHealth New Jersey commercial members.

It is very important that providers use the NaviNet? web portal to verify member-specific requirements or refer to the precertification lists on our website. Failure to obtain prior authorization for any of the services or drugs that require it may result in a reduction in payment or nonpayment for the services not authorized.

Please call 1-800-275-2583 if you have any questions about this change.

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CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. The AMA assumes no liability for data contained or not contained herein.