Authorization required depending on coverage. It is requested via fax sending a copy of the medical order the health plan.

  • CT
  • MRI
  • PET-CT
  • Nuclear Medicine
  • Ultrasound-Does not require authorization.


Require PCP referral LDEL for the following coverage:

InteliCare OSS, OSS Platinum, Platinum Special HMO SNP, HMO SNP Ideal Platinum.

  • CT
  • MRI
  • PET-CT
  • Nuclear Medicine
  • Ultrasound - Does not require authorization or referral.

Does not require PCP referral the following coverage:

  • MA OSS
  • Advance Health
  • Avon
  • Premium IEAs OSS Group
  • MAPD Classicare
  • Premium ELA Group
  • Premium OSS
  • Premium Silver Group
  • UPR Retirement System

The vast majority require sending of the medical order and / or PCP referral by fax to the health plan.  Platinum Coverage - needs authorization and referral.