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Radiology prior authorization

These programs support the consistent use of evidence-based, professional guidelines for diagnostic imaging procedures. They help reduce risks to patients and improve the quality, safety and appropriate use of imaging procedures.

Prior authorization

To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal.

Sign in Prior authorization

Basic requirements and process

Prior authorization may be required for these advanced outpatient imaging procedures:

  • CT scans*
  • MRIs*
  • MRAs*
  • PET scans
  • Nuclear medicine studies, including nuclear cardiology

 

Authorization is not required for procedures performed in an emergency room, observation unit, urgent care center or during an inpatient stay.

*Note: For Medicare Advantage and Dual Special Needs Plan (D-SNP) benefit plans, prior authorization is not required for a CT, MRI or MRA.

 

These requirements apply to all providers subject to the UnitedHealthcare Administrative Guide. To review the complete protocol, please refer to the Outpatient Radiology Prior Authorization Protocol section in that guide.


For further information on related imaging policies, see Imaging Accreditation.

Specific radiology programs by plan

Open the section below to view more information.

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This program is effective in Arizona, Florida, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington and Wisconsin.

Cardiovascular and Radiology Imaging Guidelines
2025
2024
Maryland-specific authorization resources
Radiology prior authorization resources
Cardiovascular and Radiology Imaging Guidelines
Effective Nov. 15, 2024
Effective Feb. 1, 2024
Cardiovascular and Radiology Imaging Guidelines
2025
2024
Radiology prior authorization resources

The following commercial resource materials are inclusive of the UnitedHealthcare River Valley and Neighborhood Health Partnership (NHP) membership.

Cardiovascular and Radiology Imaging Guidelines
2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
2024
Radiology prior authorization resources
Cardiovascular and Radiology Imaging Guidelines
2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 04.21.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 03.01.2025
  • Commercial and Exchange Plans Cardiovascular and Radiology Imaging Guidelines - Effective 02.01.2025
2024
Radiology prior authorization resources

For information about UnitedHealthcare Oxford policies, please refer to our UnitedHealthcare® Oxford Clinical, Administrative and Reimbursement Policies. This page has all UnitedHealthcare Oxford clinical, administrative and reimbursement policies, including the following commonly referenced clinical guidelines and imaging policies:

Cardiovascular and Radiology Imaging Guidelines
2025
2024
2023
Radiology prior authorization resources