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3.2 Services, Benefits, Limitations, and Prior Authorization
The following high-technology (high-tech) radiology services may be reimbursed by Texas Medicaid with prior authorization:
• Cardiac nuclear imagining
•Computed tomography (CT)
•Computed tomography angiography (CTA)
•Magnetic resonance imaging (MRI)
•Magnetic resonance angiography (MRA)
•Positron emission tomography (PET) scan imaging
Note: Providers and facilities are required to use the lowest possible radiation dose that is consistent with acceptable image quality for cardiac nuclear imaging, CT, and PET examinations of all clients. It is recommended that providers and facilities use national standards such as those established by the American College of Radiology in their ACR Practice Guidelines and Technical Standards manual.
Radiology interpretations in any place of service and ultrasound interpretations in the inpatient hospital setting will be denied if they are billed by the attending physician. Services that are billed by the attending physician are included in the facility fee and are not reimbursed separately.
Note: The 3-dimensional (3-D) obstetric ultrasound is not a benefit of Texas Medicaid.
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