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Virginia Administrative Code (Last Updated: January 10, 2017) |
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Title 12. Health |
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Agency 30. Department of Medical Assistance Services |
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Chapter 50. Amount, Duration, and Scope of Medical and Remedial Care Services |
Section 120. Other laboratory and x-ray services
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A. Services must be ordered or prescribed and directed or performed within the scope of a license of the practitioner of the healing arts.
B. Prior authorization is required for the following nonemergency outpatient procedures: Magnetic Resonance Imaging (MRI), including Magnetic Resonance Angiography (MRA), Computerized Axial Tomography (CAT) scans, including Computed Tomography Angiography (CTA), or Positron Emission Tomography (PET) scans performed for the purpose of diagnosing a disease process or physical injury. The referring physician ordering the scan must obtain the prior authorization in order for the servicing provider to be reimbursed for the scan. Nonemergency outpatient MRI, CAT and PET scans that are not prior authorized will not be covered or reimbursed by the Department of Medical Assistance Services (DMAS).
Historical Notes
Derived from VR460-03-3.1100 § 3, eff. June 30, 1993; amended, Volume 10, Issue 22, eff. September 1, 1994; Volume 20, Issue 01, eff. October 22, 2003; Volume 22, Issue 16, eff. July 3, 2006.