These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Providers in all locations except for the counties in Wisconsin listed below must comply with decision support requirements when ordering diagnostic imaging. Approved decision support solutions will utilize criteria to determine the appropriateness of any diagnostic imaging ordered for HealthPartners' members. Please see related content at right for a link to HealthPartners Administrative Policy, Diagnostic Imaging Provider Notification Program, for additional information.
Providers in these Wisconsin counties are exempt from decision support: Brown, Calumet, Door, Fond Du Lac, Florence, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, and Shawano. CTs, MRIs, and PET scans in those counties are covered without prior authorization or decision support.
Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) scans as defined below are generally covered to diagnose a medical condition provided the decision support process above has been followed and according to your plan documents.
Please see related content at the right for unique policies where coverage criteria or different benefits may apply: Breast specific gamma imaging (BSGI), and Cone-beam computed tomography (CT) scan for medically-related dental services. Low dose CT for Lung Cancer screening is described on the Preventive Services for Adults policy.
Computed Tomography (CT or CAT scan) is an imaging method that uses x-rays to create pictures of cross-sections of the body.
Electron-beam computed tomography (EBCT) is a test that looks for specks of calcium (called calcifications) in the walls of the coronary arteries.
Magnetic resonance imaging (MRI) uses a large magnet and radio waves to look at organs and structures inside the body.
Magnetic Resonance Angiography (MRA) is a non-invasive technique MRI technique used to diagnose blood vessel patency or blood flow abnormalities.
Multidetector CT (MDCT) scans take images of the beating heart, and show calcium and blockages in the heart arteries.
PET (Positron Emission Tomography) produces high energy, 3-D computer-reconstructed images measuring and determining the function or physiology in a specific organ, tumor, or other metabolically active site.
Virtual colonoscopy (VC) (or Computerized Tomographic Colonography (CTC) uses x rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
- 12/19/2014 - Date of origin
- 12/01/2017 - Effective date