Blue Cross and Blue Shield of Alabama network referring providers are required to obtain precertification from Carelon for the following services prior to scheduling:

• Positron emission tomography (PET) scans
• Computerized axial tomography (CT) scans
• Computed tomographic angiography (CTA) scans
• Magnetic resonance imaging (MRI) tests
• Magnetic resonance angiography (MRA) tests

Referring providers include Preferred Medical Doctors (PMDs), Blue Advantage^®, Participating Chiropractors, Preferred Certified Registered Nurse Practitioners and Preferred Physician Assistants.

Precertification applies to:

• Office-based imaging
• Freestanding imaging facilities  
• Outpatient hospital referrals

Imaging services ordered during the treatment of a patient while in the emergency room, from an observation unit or during inpatient stays do not require precertification. Request precertification for advanced imaging services online through Eligibility and Benefits or by calling toll-free at 1-866-803-8002. 

If a referring physician fails to obtain a precertification or if the precertification is not approved due to lack of medical necessity, the claim from the imaging provider will be denied and the patient will be held harmless.

Note: For information about the Preferred Radiology Program, refer to the Preferred Radiology Program page.

Additional Resources:

Preferred Authorization Program
CPT Codes Requiring Precertification
Precertification of Advanced Imaging Services FAQs 

Medical Policies:
Advanced Imaging Policies
Blue Advantage Advanced Imaging Policies

Carelon is an independent company that provides clinical solutions that drive appropriate, safe and affordable care.