Imaging
Select Sub-section
Indicates Non-Covered Service
Cardiac Computed Tomography (CCT)
& Coronary
Computed Tomography Angiography (CCTA)
Cardiac Single-Photon Emission Computed Tomography (SPECT)
Coronary Artery Calcium Scoring & Coronary Computed Tomography Angiography
Computed Tomographic (CT) Colonography for Diagnostic Uses (L33562)
Computerized Diagnostic Imaging for Complex Maxillofacial Procedures
CT
Abdomen & Pelvis
CT Angiography, Abdominal Arteries
CT Angiography, Abdomen
CT Angiography, Abdomen & Pelvis
CT Angiography, Chest (non coronary)
Computed Tomographic Angiography (CTA) Heart
-Medicare-
CT Angiography, Head/Brain
Computed Tomography Angiography (CTA) Brain (Head)
CT Angiography, Lower Extremity
Computed Tomography Angiography (CTA) Neck
CT Angiography Pelvis
CT Angiography, Upper Extremity
-FloridaBlue-
-FloridaBlue-
-FloridaBlue-
Lung Cancer Screening - CT
Multiple Imaging
in Oncology
Sinus Maxillofacial CT
Temporal Bone, Mastoid, Orbits & MaxillofacialCT
Computed Tomography to Detect Coronary Artery Calcification
-FloridaBlue-
-FloridaBlue-
-FloridaBlue-
Magnetic Resonance Angiography (MRA) Neck
-FloridaBlue-
MRI Angiography (MRA) of the Pelvis
-Medicare-
MR Angiography Upper Extremity
Magnetic Resonance Angiography of Vessels of the Head, Neck, Abdomen, Pelvis & Lower Extremity
Magnetic Resonance Angiography (MRA) & Magnetic Resonance Venography (MRV)
MRI
Abdomen
-Humana-
Magnetic Resonance Imaging (MRI) Abdomen & Pelvis
-FloridaBlue-
-Aetna
Magnetic Resonance Imaging (MRI) Brain & Head
-FloridaBlue-
MRI Brain (includes Internal Auditory Canal)
Magnetic resonance imaging (MRI) of the Cardiovascular System
-Aetna
-Humana-
MRI of Face, Neck, Orbit & Sinus
MRI
Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
MRI Heart
MRI to Monitor Integrity of Silicone Gel-Filled Breast Implants
MRI Orbit, Face, Temporo-mandibular Joint (TMJ) & Neck
MRI Pelvis
-FloridaBlue-
MRI Spectroscopy (MRS)
MRI TMJ
Multiparametric MRI Fusion Imaging Targeted Prostate Biopsy
Multiple Imaging
in Oncology
Orbit, Face, Neck, Sinus MRI
-Aetna
-FloridaBlue-
Magnetic Resonance Spectroscopy
MRI Low Field
Positional
MRI
Videofluoros-copy, Dynamic MRI for Musculoskel-etal Indications
-Humana-
Not-covered
AndreView (Iobenguane
I-123 injection)
CEA-Scan
Cholecystokinin Cholescintigraphy
Hepatobiliary Imaging
Lympho-scintigraphy & Sentinel Lymph Node Biopsy
Malignant Melanoma Surveillance
-Cigna-
Meta-Iodobenzyl-guanidine (MIBG) Imaging & Therapy
Myocardial Perfusion Imaging (Nuc Card)
Cardiac Nuclear Imaging (Myocardial Perfusion Imaging)
OctreoScan
Oncoscint Immunoscin-tigraphy
ProstaScint
Radioactive Seed Localization of Nonpalpable Breast Lesions
-FloridaBlue-
Radioimmuno-scintigraphy Imaging (Monoclonal Antibody Imaging) Using In-111 Satumomab Pendetide (OncoScint) or Tc-99m Arcitumomab (IMMU-4, CEA-Scan)
Scintigraphy of Acute Deep Venous Thrombus
Scintigraphy & Uptake Measurement for Benign & Malignant Thyroid Disease
Scintimammography & Gamma Imaging of the Breast & Axilla
Technetium-99m-Sestamibi Scintigraphy
Technetium-Tc 99m Tilmanocept (Lymphoseek)
Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure
Radioimmuno-scintigraphy Imaging (Monoclonal Antibody Imaging) Using Technetium-99m Nofetumomab Merpentan (Verluma)
Radioimmuno-scintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
AcuTect Scintigraphic Imaging for Detection of Lower Limb Deep Vein Thrombosis
-Aetna-
Cerebrospinal Fluid Flow SPECT
Dopamine Transporter Imaging with Single Photon Emission Computed Tomography (DAT-SPECT
Gallium Ga68 Dotatate Scan
-FloridaBlue
Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment
Kidney SPECT
Liver SPECT
Oncologic Applications of PET Scanning
-FloridaBlue
PET & PET-CT Fusion for Oncologic Conditions
SPECT/CT Fusion Imaging
Single Photon Emission Computed Tomography (SPECT)
-Aetna-
Beta Amyloid Imaging with Positron Emission Tomography (PET) for Alzheimer's Disease
Positron Emission Mammography (PEM)
Abdominal Echography
Arterial Ultrasound (Duplex Ultrasounds & Physiologic Testing)
Breast Echography (Sonography)
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
Color-Flow Doppler Echocardiography in Adults
Duplex Scan of Hemodialysis Access
-FloridaBlue-
Duplex Scan
for Erectile Dysfunction
Duplex Scan Of Lower Extremity Arteries
Duplex Scanning of Aorta, Inferior Vena Cava, Iliac Vasculature, or Bypass Grafts
Duplex Scanning of Arterial Inflow and Venous Outflow of Abdominal, Pelvic, Scrotal Contents and/or Retroperitoneal Organs
Non-Invasive Evaluation of Extremity Veins
Endobronchial Ultrasound for Diagnosis & Staging of Lung Cancer
Fetal Echocardiography
Intracoronary Doppler Ultrasound
Noninvasive Assessment
of Hepatic Fibrosis
Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries
Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries for HBO
Noninvasive Vascular Studies of Abdominal, Pelvic, Scrotal Contents / Retroperitoneal Organs
Non-Obstetric Gynecologic Duplex Ultrasonography of the
Abdomen & Pelvis
Non-obstetric
Pelvic
Ultrasound
Non-Vascular Extremity Ultrasound
Post-Voiding Residual Ultrasound
Stress
Echo-cardiography
Transcranial Doppler
Studies
Transesophageal Echocardiogram
Transient Elastography (FibroScan)
Transthoracic Echocardiography (TTE)
Transthoracic Echocardiography in Adults
Transrectal Ultrasound
Transvaginal Ultrasonography (TV-US)
Ultrasound in Maternity Care
-FloridaBlue
Ultrasound for Pregnancy Plus Detailed Fetal Anatomic Examination
Ultrasound
Retroperitoneum
Ultrasound, Soft Tissues of Head & Neck
Quantitative Ultrasound for Tissue Characterization
-Anthem-
-FloridaBlue
Ultrasound for the Evaluation of Paranasal Sinuses
Ultrasono-graphic Evaluation of Skin Lesions
Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
Aortography & Peripheral Angiography- Abdominal Aortography
Aortography & Peripheral Angiography- Iliac & Lower Extremity Angiography
Aortography & Peripheral Angiography- Renal
Angiography
Aortography & Peripheral Angiography-
Thoracic & Carotid Aortography
Three-Dimensional (3-D) Rendering, Interpretation & Reporting of Imaging
Studies
Barium Swallow Studies Modified Dysphagia With Secondary Diagnosis
-Anthem-
Barium Swallow Studies, Modified: Pneumonitis Due to Inhalation of Food & Vomit
Barium Swallow Studies Modified Sequelae Of Cerebrovascular Disease
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
Chest
X-Ray
Diagnostic Abdominal Aortography & Renal
Angiography
Digital Breast Tomosynthesis
Ductography
Radiologic Examination Chest
Renal
Angiography
Screening Mammography
Sinus
X-ray(s)
Swallow
Evaluation & Dysphagia Treatment
Thoracic Aortography & Carotid, Vertebral, & Subclavian Angiography
Computerized Motion Diagnostic Imaging
Aetna
Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradio-graphy/ Videofluoros-copy)
Thermography
-Aetna-
-UHC-
Videofluoro-scopic Evaluation of Velopharyngeal Dysfunction
Whole Body Dual X-ray Absorptiometry (DEXA) to Determine Body Composition
Cigna-
-FloridaBlue-
-Anthem-
91110, 91111, 0355T, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492,70496, 70498, 71250, 71260,71270, 71275, 72125, 72126,72127, 72128, 72129, 72130,72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200,73201, 73202, 73206, 73700,73701, 73702, 73706, 74150,74160, 74170, 74174, 74175,74176, 74177, 74178, 74261,74262, 75572, 75573, 75574,75635, 76380, 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936, 70336, 70540, 70542, 70543, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73718, 73719, 73720, 73721, 73722, 73723, 74181, 74182, 74183, 74712, 75557, 75559, 75561, 75563, 77046, 77047, 77048, 77049, 77084, C8903, C8905, C8906,C8908, C9762, C9763, S8037, S8042, 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 93350, 93351, C8928, C8930, 93303, 93304, 93306, 93307, 93308, C8921, C8922, C8923, C8924, C8929, 36245, 36246, 36247, 78429, 78430, 78431, 78432, 78433, 78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, G0219, G0235, G0252, 78494, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93355, C8925, C8926, C8927,
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