Effective 4/1/2021, PacificSource Health Plans (Commercial) will require prior authorization for all of the following Nuclear Medicine and SPECT CT codes below.  PacificSource Medicare Advantage prior authorization requirements will be effective 6/1/2021. Authorizations should be submitted to AIM Specialty Health:

78195,78201, 78202, 78215, 78216, 78226 , 78227, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78265, 78266, 78278, 78290, 78291, 78300, 78305, 78306, 78315, 78445, 78456, 78457, 78458, 78579, 78580, 78582, 78597, 78598, 78600, 78601, 78605, 78606, 78610, 78630, 78635, 78645, 78650, 78660, 78700, 78701, 78707, 78708 , 78709 , 78725, 78730, 78740, 78761, 78800, 78801, 78802, 78804, 78830, 78831, 78832, 78803