Med Solutions Prior Approval Exceptions

Prior Approval (PA) is not required for radiology in certain circumstances, including:
- an emergency room visit
- an urgent care visit (only for urgent care, not primary care)
- a referral from a hospital emergency department or an urgent care.

To indicate a procedure is performed in any of the above circumstances, providers must enter the appropriate CPT code with modifier U2. If the U2 modifier is not entered on the claim, the claim will deny indicating a MedSolutions PA is needed.

Further information regarding these guidelines can be found in DMA Clinical Coverage Policy 1K-7 High Tech Imaging and Ultrasound Procedure Codes. (See link below)