Radiology services requests

Advanced imaging services

Advanced imaging includes CT, CTA, MRA, MRI, and PET services. Submit your request through the Referral Request tool .

Puget Sound region providers: All radiology requests for services at a Kaiser Permanente facility must include a completed Radiology imaging request form (PDF).

*Radiology requests for MRIs must also include a completed MRI questionnaire (PDF) .

Kaiser Permanente requires prior authorization for computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and positron emission tomography (PET) services to ensure clinically appropriate imaging for our members. In order to ensure appropriate utilization, we refer to the evidence-based American College of Radiology (ACR) guidelines as our clinical review criteria.

Note: Claims adjudication requires prior authorization for payment. If no authorization is present, we will deny the claim to the provider's financial liability. The denial will impact the rendering provider's claims; that is, the provider providing the imaging service, not the provider ordering the service.

To expedite patient care, please check the CPT code in the PreAuthorization Code Check Tool. The tool will inform you if an authorization is needed. If it is needed and there is documentation indicated for the review, please attach those records to your referral request in Affiliate Link.

Imaging services requiring prior authorization

Services requiring prior authorization include but are not limited to:

• CT scans of abdomen, chest, head, lumbar spine, soft-tissue neck, facial bone, pelvis, sinus, and extremities
• MRI/MRA scans of abdomen, head, chest, cervical spine, hip, knee, lumbar spine, soft-tissue neck, shoulder, thoracic spine, and extremities

These services continue to require prior authorization with submission of medical records for review:

• Positron emission tomography (PET)
• Breast MRI
• CT colonography
• CT angiography
• Whole body CT
• Discography
• Single photon emission computed tomography (SPECT) for behavioral health indications
• MRA for behavioral health indications

Please attach medical records to the request you submit in Affiliate Link for faster processing. If you must, you can fax medical records to 1-800-377-8853 (this is for records only - not for prior authorization requests).

Exception: PPO plans (PDF)

Imaging services not requiring prior authorization

Imaging services that do not require prior authorization include those ordered and provided during:

• Emergency room visits
• Hospital-based urgent care
• Hospital inpatient services
• Ambulatory surgery procedures

For questions, contact the Provider Assistance Unit (PAU) at 1-888-767-4670.