1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY.
Privileging ... SPECIALTY. CPT CODES ... Interventional Cardiology. 71090 ...
1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Primary Care Physicians: Internal Medicine, Family Practice, Pediatrics
71010, 71020, 71021, 71022, 71030, 71100, 71101, 71110, 72010 , 72020, 72040, 72050, 72052, 72070, 72080,72082 72100, 72110, 72114, 72170, 73000, 73010, 73020, 73030, 73050, 73060, 73070, 73080, 73090, 73092, 73100, 73110, 73120, 73130, 73140, 73500 ,73501, 73502, 73503, 73510 , 73520 , 73521, 73522, 73523 73540, 73550 ,73551, 73552, 73560, 73562, 73564, 73565, 73590, 73592, 73600, 73610, 73620, 73630, 73650, 74000, 74010, 74020, 74022 ,77080, 77081
Focus on chest x-ray, abdominal x-ray, and long bones. Exclude code 77080 and 77081 for Pediatrics.
Allergy & Immunology
71010, 71020, 71021, 71022, 71030
Focus on chest x-ray
Anesthesia
72275, 72285, 72291, 72292, 72295, 77003
Diagnostic and localization tests for pain management. Italicized codes are no longer curren t
Breast Surgeon
77051 , 77052 , 77053, 77054, 77055 , 77056 , 77057 , 77058, 77059, 77065, 77066, 77067 76645,76641,76642
Breasts and mammography x-rays. Italicized code are no longer current.
Cardiology (Includes Cardiothoracic Surgery and Cardiovascular Disease)
71010, 71020, 71021, 71022, 71030, 76930**, 78414, 78428, 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, 75635,75574, 70498, 71275
Focus on chest x-ray, nuclear cardiology, echocardiology, and x-ray incidental to injections or biopsies. Procedures requiring prior authorization
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Pediatric Cardiology
71010, 71020, 71030, 76825, 76826, 76827, 76828
Plain films and x-ray incidental to injections and/or biopsy
Interventional Cardiology
71090, 75625, 75630, 75650 , 75658, 75660 , 75662, 75665, 75671 , 75676 , 75680, 75685, 75710, 75716,75722, 75724, 75726, 75756, 75774, 75896, 75898, 75960, 75962, 75964, 75966, 75968
Peripheral vascular x-rays. Italicized codes are no longer current
Chiropractic
72010 , 72020, 72040, 72050, 72052, 72069, 72070, 72080,72081, 72082, 72083, 72084, 72090 , 72100, 72110, 72114
Spinal x-ray
Critical Care
** 75790 , ** 75894,** 75978, **76937
Emergency Medicine
71010, 71020, 71021, 71022, 71030, 71100, 71101, 71110, 72010 , 72020, 72040, 72050, 72052, 72070, 72080,72082 72100, 72110, 72114, 72170, 73000, 73010, 73020, 73030, 73050, 73060, 73070, 73080, 73090, 73092, 73100, 73110, 73120, 73130, 73140, 73500, 73501, 73502,73503 73510, 73520, 73521, 73522,73523 73540 , 73550 ,73551,73552 73560, 73562, 73564, 73565, 73590, 73592, 73600, 73610, 73620, 73630, 73650, 73660, 74000, 74010, 74020, 74022
Services related to trauma and acute conditions.
Endocrinology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 76536, 76942, 77080, 77082 , 77081,77086
Chest and abdominal x-rays, utrasound guidance services, and bone densitometry services. Italicized code is no longer current.
Angiography, transcatheter procedures, ultrasonic guidance. Italicized code is no longer current
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Gastroenterology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 76975 76700
Urgent x-rays associated with GI diagnoses.
General Dentistry, Dental Facility, Dentistry Endodontics/Periodotics
70300, 70310, 70320, 70350, 70355
All dental x-rays
Geriatric Medicine
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022
*General medical management services
Gynecology Oncology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 76700, 76801, 76830, 76856, 76942,76857
Diagnostic of uterus (transabdominal and transvaginal), first trimester ultrasounds, and image guided biopsies.
Gynecology Only
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 74740,76641,76642 76645 , 76700, 76801, 76830, 76831, 76856, 76857, 76942, 76948, 77080, 77081
Diagnostic of uterus (transabdominal and transvaginal) and first trimester ultrasounds, bone densitometry. Italicized code is no longer current.
Hand Surgery
73000, 73010, 73020, 73030, 73050, 73060, 73070, 73080, 73090, 73092, 73100, 73110, 73120, 73130, 73140, 77071, 76942, 76881, 76882,
Plain films of the upper extremities.
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Head and Neck Surgery
70371, 76942
X-ray for biopsy
Hematology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 71100
*General medical management services
Infectious Disease
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022
*General medical management services
Maternal and Fetal Medicine/ Neonatal-Perinatal Medicine
76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76818, 76819, 76820, 76821,76825, 76826, 76827, 76828, 76830, 76831, 76856, 76857, 76941, 76942, 76945, 76946, 76948
All obstetric ultrasound and x-ray associated with fertility evaluation
*General medical management services Nephrology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 76770 ***75978, ***75710, ***75791, ***75962
Neurology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 76942, 76881, 76882,
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
***payable to a boarded Nephrologist for management of the renal dialysis patients.
*General medical management services
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Neurosurgery
77001, 77002, 77003, 72040, 76942, 76881, 76882,
Fluoroscopic guidance services
Obstetrics & Gynecology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 74740, 76641,76642, 76645 , 76700, 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 78616, 76817, 76818, 76819, 76820, 76821, 76830, 76831, 76856, 76857, 76942, 76945, 76946, 76948, 77080, 77081, 76857
All gynecologic and obstetric x-ray, bone densitometry. Italicized code is no longer current.
Occupational Medicine
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022
*General medical management services
Oncology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 71100
*General medical management services
Ophthalmology
70030, 76510, 76511, 76512, 76513, 76514, 76516, 76519, 76529
Studies of the eye
Oral Surgery
70100, 70110, 70140, 70150, 70300, 70310, 70320, 70328, 70330, 70350, 70355
Dental, jaw, and face x-ray services
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Orthopaedic Surgery
71100, 71101, 71110, 71120, 71130, 72010 , 72020, 72040, 72050, 72052, 72069 , 72070, 72080,72081, 72082,72083,72084, 72090 , 72100, 72110, 72114, 72120, 72170, 72190, 72200, 72220, 73000, 73010, 73020, 73030, 73050, 73060, 73070, 73080, 73090, 73092, 73100, 73110, 73120, 73130, 73140, 73500 ,73501, 73502,73503, 73510, 73520 , 73521, 73522,73523,73540 , 73550 , 73551, 73552, 73560, 73562, 73564, 73565, 73590, 73592, 73600, 73610, 73620, 73630, 73650, 73660, 76000, 76881, 76882, 76942, 77001, 77002, 77003, 77071, 77072, 77073, 77074, 77075, 77076, 77080, 77081
Plain films of the bones and fluoroscopic guidance
Otolaryngology
70210, 70220, 70371, 76536, 76942
X-ray for biopsy & procedure
Pain Medicine
70371, 72275, 72285, 72291, 72292, 72295, 76942, 77001, 77002, 77003,
Diagnostic and localization tests for pain management, x-ray for needle guided procedures. Italicized codes is no longer current
Physical Medicine & Rehabilitation
77001, 77002, 77003, 70371, 76942, 76881, 76882
X-ray for needle guided procedures
Plastic Surgery
76000, 77077
Fluoroscopy, joint survey
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Podiatric Surgery
73600, 73610, 73620, 73630, 73650, 73660, 77071
Plain film of the feet
Podiatry
73600, 73610, 73620, 73630, 73650, 73660, 77071
Plain films of the feet
Pulmonary Disease
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022
*General medical management services
Reproductive Endocrinology
71010, 71020, 71021, 71022, 71030, 74000, 74010, 74020, 74022, 74740,76641,76642 76645 , 76700, 76801, 76802, 76805, 76810, 76811, 76812,76813, 76814, 76815, 76816, 76817, 76818, 76819, 76820, 76821, 76830, 76831, 76856, 76857, 76942, 76945, 76946, 76948
Encompass the services related to endocrine and obstetric/gynecology xray, all x-ray guided procedures, and retrievals. Italicized code are no longer current
Rheumatology
71010, 71020, 71021, 71022, 71030, 72202, 74000, 74010, 74020, 74022, 77080, 76942, 76881, 76882, 77080, 77081
*General medical management services, radiologic examination, bone densitometry
Surgery
76937, 76942
Guided biopsies
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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1199SEIU BENEFIT FUND RADIOLOGY PRIVILEGING LIST BY SPECIALTY
Updated 7/11/2017
Privileging standards apply to all participating and non participating physicians.
SPECIALTY
CPT CODES
DESCRIPTION
Urology
74400, 74410, 74415, 74420, 74425, 74430, 74440, 74445, 74450, 74455, 76870, 76872, 76775, 76873, 76942, 76856
Genital x-ray procedures and biopsy procedures
Vascular Surgery
75625**, 75630**, 75650 **, 75658**, 75660 **, 75662 **, 75665 **, X-rays related to angiography, 75671**, 75676**, 75680**, 75685** , 75710, 75716**, 75722* *, 75724** , 75726**, 75736**, 75756**, 75774**,75790 , 75791**, venography, and other invasive vascular 75820**, 75827, 75833**, 75894**, 75896**, 75898**, 75940** , services, fluoroscopic guidance services. Italicized codes are no longer current 75952**, 75953**, 75960**, 75962, 75964**, 75966**, 75968**, 75978,76937 77001, 77002, 77003
Urgent Care Centers may perform all radiology services except MRIs, MRAs, CAT PET Scans *General medical management services denotes specialties where privileging may encompass procedures similar to IMED **Approved for hospital setting only
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