Provider Alert! Fetal Magnetic Resonance Imaging (MRI) Requires Prior Authorization

Date: October 11, 2021

Attention: All Providers

Effective Dates: June 1, 2021 for code 74712 and April 1, 2021 for code 74713

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Network providers submitting a prior authorization for fetal Magnetic Resonance Imaging (MRI) should include a current clinic note dated within 30 days of the authorization request stating the need for the fetal MRI. Fetal MRI (codes 74712 and 74713) is a benefit for pregnant TCHP members.

How this impacts providers: Indications for Fetal MRI include:

• An abnormality on ultrasound is not clearly defined and more information is sought in order to make a decision about therapy, delivery, or to advise a family about prognosis (ie: potential anomaly in the setting of maternal obesity, oligohydramnios, or advanced gestational age)
• An abnormality is identified on ultrasonography and the treating physician desires MRI-specific information in order to make decisions about care.
• A fetus is significantly at risk for abnormality that will affect prognosis even if no finding is discovered with ultrasound (i.e.: neurologic ischemia after laser ablation of placental anastomoses in Twin-Twin Transfusion Syndrome).

Next steps for providers: Providers should share this communication with their staff.

Resource:

https://www.pedrad.org/Specialties/Fetal-Imaging/Fetal-MRI-General-Information#38201363-references

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.