Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 50. Amount, Duration, and Scope of Medical and Remedial Care Services

12VAC30-50-120. Other laboratory and x-ray services.

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).

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-03-3.1100 § 3, eff. June 30, 1993; amended, Virginia Register Volume 10, Issue 22, eff. September 1, 1994; Volume 20, Issue 1, eff. October 22, 2003; Volume 22, Issue 16, eff. July 3, 2006.

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