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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.61 Radiology Services : 9.2.61.2 Cardiac Blood Pool Imaging

9.2.61.2
Cardiac blood pool imaging may be reimbursed with procedure codes 78472, 78473, 78481, 78483, 78494, and 78496. Prior authorization is required for outpatient diagnostic services.
Refer to:
Subsection 9.2.26.9, “Myocardial Perfusion Imaging,” in this handbook for more information about myocardial perfusion imaging.
Section 3, “Radiological and physiological laboratory services” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks) for additional information and authorization requirements.

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