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July 2014 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 3. Radiological and physiological laboratory services : 3.2 Services, Benefits, Limitations, and Prior Authorization : 3.2.2 Computed Tomography and Magnetic Resonance Imaging

3.2.2
CT, CTA, MRI, fMRI, and MRA services are benefits of Texas Medicaid.
The following procedure codes may be reimbursed with prior authorization for CT, CTA, MRI, fMRI, and MRA radiology services:
Texas Medicaid may reimburse the total component for procedure codes 76497 and 76498 when the service is rendered in the office and outpatient hospital setting by radiation treatment center providers.
The professional component may be reimbursed when the service is rendered in the office, inpatient hospital, or outpatient hospital setting by physician providers.
The technical component will be a benefit when rendered in the office setting by physician, radiation treatment center, portable X-ray supplier, radiological laboratory, and physiological laboratory providers.
Procedure codes 76497 and 76498 will be a benefit when rendered in the outpatient hospital setting by radiation treatment center providers.
The following revenue codes must be billed with the most appropriate corresponding procedure code for CT, CTA, MRI, fMRI, and MRA radiology services rendered by outpatient hospital providers:
The addition of post 3-D reconstruction (procedure codes 76376 and 76377) CT, CTA, MRI, and MRA studies must be prior authorized. No additional payment will be made in absence of prior authorization.

Texas Medicaid & Healthcare Partnership
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