List of Advanced Imaging Procedures Included in the PAMA Mandate

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1 List of Advanced Imaging Procedures Included in the PAMA Mandate PROCEDURE ID PROCEDURE RECORD NAME PROCEDURE MASTER # CT ABDOMEN ADRENAL WITH AND WITHOUT PELVIS WITH IMG CT ABDOMEN PELVIS HEMATURIA W WO CONTRAST IMG CT ABDOMEN PELVIS SPIRAL FOR STONE IMG CT ABDOMEN PELVIS SPIRAL FOR STONE FOLLOW UP IMG CT ABDOMEN PELVIS W CONTRAST IMG CT ABDOMEN PELVIS W WO CONTRAST IMG CT ABDOMEN PELVIS WO CONTRAST IMG CT ABDOMEN W WO AND CT PELVIS W CONTRAST IMG CT BRAIN 3D WO CONTRAST IMG CT BRAIN STROKE IMG CT BRAIN W CONTRAST IMG CT BRAIN W WO CONTRAST IMG CT BRAIN WO CONTRAST IMG CT CARDIAC CALCIUM SCORE IMG CT CERVICAL SPINE W CONTRAST IMG CT CERVICAL SPINE W WO CONTRAST IMG CT CERVICAL SPINE WO CONTRAST IMG CT CHEST LIMITED STUDY WO CONTRAST IMG CT CHEST LUNG CANCER SCREENING IMG CT CHEST LUNG LOW DOSE DIAGNOSTIC FOLLOW UP IMG CT CHEST W CONTRAST IMG CT CHEST W WO CONTRAST IMG CT CHEST WO CONTRAST IMG CT HEAD MSU W CONTRAST IMG CT HEAD MSU WO CONTRAST IMG CT HIP BILAT W CONTRAST IMG CT HIP BILAT WO CONTRAST IMG CT KIDNEY TRIPLE PHASE W PELVIS IMG CT LIVER TRIPLE PHASE W PELVIS IMG CT LOWER EXTREMITY BILAT W CONTRAST IMG CT LOWER EXTREMITY BILAT WO CONTRAST IMG CT LOWER EXTREMITY LT W CONTRAST IMG CT LOWER EXTREMITY LT W WO CONTRAST IMG CT LOWER EXTREMITY LT WO CONTRAST IMG CT LOWER EXTREMITY RT W CONTRAST IMG CT LOWER EXTREMITY RT W WO CONTRAST IMG CT LOWER EXTREMITY RT WO CONTRAST IMG CT LUMBAR SPINE W CONTRAST IMG CT LUMBAR SPINE W WO CONTRAST IMG CT LUMBAR SPINE WO CONTRAST IMG CT CHEST LUNG CANCER SCREENING SHORT TERM FOLLOW IMG CT PANCREAS TRIPLE PHASE W PELVIS IMG CT PELVIS BONY W CONTRAST IMG CT PELVIS BONY WO CONTRAST IMG CT PELVIS W CONTRAST IMG CT PELVIS W WO CONTRAST IMG CT PELVIS WO CONTRAST IMG CT PITUITARY W CONTRAST IMG CT PITUITARY W WO CONTRAST IMG CT PITUITARY WO CONTRAST IMG CT SINUS SURVEY IMG CT SINUSES W CONTRAST IMG CT SINUSES W WO CONTRAST IMG CT SINUSES WO CONTRAST IMG4266

2 CT TRAUMA CHEST IMG CT UPPER EXTREMITY LT W CONTRAST IMG CT UPPER EXTREMITY LT W WO CONTRAST IMG CT UPPER EXTREMITY LT WO CONTRAST IMG CT UPPER EXTREMITY RT W CONTRAST IMG CT UPPER EXTREMITY RT W WO CONTRAST IMG CT UPPER EXTREMITY RT WO CONTRAST IMG CTA CHEST PE IMG CTA CHEST W WO CONTRAST IMG CTA CHEST WITH CONTRAST IMG CTA CORONARY IMG CTA GATED THORACIC AORTA IMG MRA BRAIN W CONTRAST IMG MRA BRAIN W WO CONTRAST IMG MRA BRAIN WO CONTRAST IMG MRA LOWER EXTREMITY LT W CONTRAST IMG MRA LOWER EXTREMITY LT W WO CONTRAST IMG MRA LOWER EXTREMITY LT WO CONTRAST IMG MRA LOWER EXTREMITY RT W CONTRAST IMG MRA LOWER EXTREMITY RT W WO CONTRAST IMG MRA LOWER EXTREMITY RT WO CONTRAST IMG MRA LOWER EXTREMITY W CONTRAST IMG MRA LOWER EXTREMITY W WO CONTRAST IMG MRA LOWER EXTREMITY WO CONTRAST IMG MRI ARTHROGRAM HIP LT IMG MRI ARTHROGRAM HIP RT IMG MRI ARTHROGRAM SHOULDER LT IMG MRI ARTHROGRAM SHOULDER RT IMG MRI BRAIN EPILEPSY W WO CONTRAST IMG MRI BRAIN EPILEPSY WO CONTRAST IMG MRI BRAIN MS W WO CONTRAST IMG MRI BRAIN MS WO CONTRAST IMG MRI BRAIN NEURO ONC IMG MRI BRAIN PITUITARY W CONTRAST IMG MRI BRAIN PITUITARY W WO CONTRAST IMG MRI BRAIN PITUITARY WO CONTRAST IMG MRI BRAIN POSTOP EPILEPSY W WO CONTRAST IMG MRI BRAIN POSTOP EPILEPSY WO CONTRAST IMG MRI BRAIN PREOP EPILEPSY W WO CONTRAST IMG MRI BRAIN PREOP EPILEPSY WO CONTRAST IMG MRI BRAIN VESSEL WALL W WO CONTRAST IMG MRI BRAIN W CONTRAST IMG MRI BRAIN W WO CONTRAST IMG MRI BRAIN WO CONTRAST IMG MRI CERVICAL SPINE SCREEN W WO CONTRAST IMG MRI CERVICAL SPINE SCREEN WO CONTRAST IMG MRI CERVICAL SPINE W CONTRAST IMG MRI CERVICAL SPINE W WO CONTRAST IMG MRI CERVICAL SPINE WO CONTRAST IMG MRI CHEST W CONTRAST IMG MRI CHEST W WO CONTRAST IMG MRI CHEST WALL W CONTRAST IMG MRI CHEST WALL W WO CONTRAST IMG MRI CHEST WALL WO CONTRAST IMG MRI CHEST WO CONTRAST IMG MRI COMPLETE SPINE NEURO ONC W WO CONTRAST IMG MRI HIP LT W CONTRAST IMG MRI HIP LT W WO CONTRAST IMG MRI HIP LT WO CONTRAST IMG MRI HIP RT W CONTRAST IMG MRI HIP RT W WO CONTRAST IMG MRI HIP RT WO CONTRAST IMG MRI LUMBAR SPINE SCREEN W WO CONTRAST IMG5707

3 MRI LUMBAR SPINE SCREEN WO CONTRAST IMG MRI LUMBAR SPINE W CONTRAST IMG MRI LUMBAR SPINE W WO CONTRAST IMG MRI LUMBAR SPINE WO CONTRAST IMG MRI NEUROGRAPHY SHOULDER LT W WO CONTRAST IMG MRI NEUROGRAPHY SHOULDER LT WO CONTRAST IMG MRI NEUROGRAPHY SHOULDER RT W WO CONTRAST IMG MRI NEUROGRAPHY SHOULDER RT WO CONTRAST IMG MRI PITUITARY W CONTRAST IMG MRI PITUITARY W WO CONTRAST IMG MRI PITUITARY WO CONTRAST IMG MRI SHOULDER LT W CONTRAST IMG MRI SHOULDER LT W WO CONTRAST IMG MRI SHOULDER LT WO CONTRAST IMG MRI SHOULDER RT W CONTRAST IMG MRI SHOULDER RT W WO CONTRAST IMG MRI SHOULDER RT WO CONTRAST IMG MRI SKULL BASE W BRAIN W WO CONTRAST IMG MRI THORACIC OUTLET W WO CONTRAST IMG NM MYOCARDIAL PERF (PH ST/R) IMG NM MYOCARDIAL PERF (ST/R) IMG NUC MED MYOCARD INFARCT IMAGING W SPECT CT IMG NUC MED MYOCARD PLANAR PERFUSION IMG NUC MED PLANAR REST AND STRESS CAR NUC MED PLANAR REST ONLY CAR NUC MED PLANAR STRESS ONLY CAR NUC MED REST SINGLE ONLY CAR NUC MED STRESS DOBUTAMINE CAR NUC MED STRESS DOBUTAMINE ECG PORTION CAR NUC MED STRESS EXERCISE CAR NUC MED STRESS EXERCISE ECG PORTION CAR NUC MED STRESS SINGLE ONLY CAR NUC MED STRESS VASODILATOR CAR NUC MED STRESS VASODILATOR ECG PORTION CAR NUC MED VIABILITY STRESS EXERCISE CAR NUC MED VIABILITY STRESS DOBUTAMINE CAR NUC MED VIABILITY STRESS EXERCISE CAR NUC MED VIABILITY STRESS VASODILATOR CAR QMRA BRAIN W WO INR IMG QMRA BRAIN WO INR IMG CT ABDOMEN ADRENAL TRIPLE PHASE IMG CT ABDOMEN W CONTRAST IMG CT ABDOMEN W WO CONTRAST IMG CT ABDOMEN WO CONTRAST IMG CT ANGIOGRAM ABD W WO CONTRAST IMG CT ANGIOGRAM ABDOMEN W CONTRAST IMG CT ANGIOGRAM CHEST ABD PELVIS W WO CONTRAST IMG CT ANGIOGRAM CHEST ABDOMEN W WO CONTRAST IMG CT ARTHROGRAM HIP LT IMG CT ARTHROGRAM HIP RT IMG CT ARTHROGRAM SHOULDER LT IMG CT ARTHROGRAM SHOULDER RT IMG CT CARDIAC MORPHOLOGY IMG CT CHEST ABDOMEN PELVIS W CONTRAST IMG CT CHEST ABDOMEN PELVIS W WO CONTRAST IMG CT CHEST ABDOMEN PELVIS WO CONTRAST IMG CT CHEST ABDOMEN W CONTRAST IMG CT CHEST W CONTRAST ABDOMEN PELVIS W WO CONTRAST IMG CT LIVER TRIPLE PHASE IMG CT PANCREAS TRIPLE PHASE IMG CT SOFT TISSUE NECK W CONTRAST IMG CT SOFT TISSUE NECK W WO CONTRAST IMG CT SOFT TISSUE NECK WO CONTRAST IMG191

4 33830 CT THORACIC SPINE W CONTRAST IMG CT THORACIC SPINE W WO CONTRAST IMG CT THORACIC SPINE WO CONTRAST IMG CT VENOGRAM BRAIN IMG CTA ABDOMEN PELVIS IMG CTA ABDOMEN PELVIS W CONTRAST IMG CTA CAROTID IMG CTA CAROTID STROKE IMG CTA CHEST ABDOMEN IMG CTA CHEST ABDOMEN PELVIS IMG CTA HEAD IMG CTA HEAD STROKE IMG CTA PELVIS IMG CTA TAVR IMG CTA UPPER EXTREMITY LT IMG CTA UPPER EXTREMITY RT IMG MRA ABDOMEN W CONTRAST IMG MRA ABDOMEN W WO CONTRAST IMG MRA ABDOMEN WO CONTRAST IMG MRA CAROTID W CONTRAST IMG MRA CAROTID W WO CONTRAST IMG MRA CAROTID WO CONTRAST IMG MRA CHEST W CONTRAST IMG MRA CHEST W WO CONTRAST IMG MRA CHEST WO CONTRAST IMG MRA PELVIS W CONTRAST IMG MRA PELVIS W WO CONTRAST IMG MRA PELVIS WO CONTRAST IMG MRA RENAL W WO CONTRAST IMG MRA RENAL WO CONTRAST IMG MRI ABDOMEN RENAL W WO CONTRAST IMG MRI ABDOMEN RENAL WO CONTRAST IMG MRI ABDOMEN SECRETIN W WO CONTRAST IMG MRI ABDOMEN W CONTRAST IMG MRI ABDOMEN W WO CONTRAST IMG MRI ABDOMEN W WO EOVIST IMG MRI ABDOMEN WO CONTRAST IMG MRI ABDOMINAL WALL W CONTRAST IMG MRI ABDOMINAL WALL W WO CONTRAST IMG MRI ABDOMINAL WALL WO CONTRAST IMG MRI ADRENAL GLANDS W CONTRAST IMG MRI ADRENAL GLANDS W WO CONTRAST IMG MRI ADRENAL GLANDS WO CONTRAST IMG MRI CARDIAC COMPLEX CONGENITAL IMG MRI CARDIAC FOR MORPH W CONTRAST IMG MRI CARDIAC FOR MORPH WO CONTRAST IMG MRI CARDIAC MORPH W WO CONTRAST IMG MRI CARDIAC W STRESS IMG W CONTRAST IMG MRI LIVER W CONTRAST IMG MRI LIVER W WO CONTRAST IMG MRI LIVER WO CONTRAST IMG MRI MULTIPLE MYELOMA PELVIS W WO CONTRAST IMG MRI MULTIPLE MYELOMA PELVIS WO CONTRAST IMG MRI NECK SOFT TISSUE ONLY W CONTRAST IMG MRI NECK SOFT TISSUE ONLY W WO CONTRAST IMG MRI NECK SOFT TISSUE ONLY WO CONTRAST IMG MRI NEUROGRAPHY PELVIS W WO CONTRAST IMG MRI NEUROGRAPHY PELVIS WO CONTRAST IMG MRI PELVIC FLOOR W WO CONTRAST IMG MRI PELVIC FLOOR WO CONTRAST IMG MRI PELVIS MERCURY PROTOCOL W CONTRAST IMG MRI PELVIS MERCURY PROTOCOL W WO CONTRAST IMG MRI PELVIS MSK W CONTRAST IMG5593

5 MRI PELVIS MSK W WO CONTRAST IMG MRI PELVIS MSK WO CONTRAST IMG MRI PELVIS W CONTRAST IMG MRI PELVIS W WO CONTRAST IMG MRI PELVIS WO CONTRAST IMG MRI THORACIC SPINE SCREEN W WO CONTRAST IMG MRI THORACIC SPINE SCREEN WO CONTRAST IMG MRI THORACIC SPINE W CONTRAST IMG MRI THORACIC SPINE W WO CONTRAST IMG MRI THORACIC SPINE WO CONTRAST IMG MRV BRAIN W WO CONTRAST IMG MRV BRAIN WO CONTRAST IMG NUC MED BONE IMAGING 3 PHASE LIMITED IMG NUC MED BONE IMAGING LIMITED IMG NUC MED BONE IMAGING SPECT CT IMG NUC MED BONE IMAGING THREE PHASE WHOLE BODY IMG NUC MED BONE IMAGING WHOLE BODY IMG NUC MED LUNG PERFUSION IMAGING IMG NUC MED LUNG QUANT DIFFERENTIAL IMG NUC MED LUNG QUANT PERFUSION IMG NUC MED LUNG VENT PERF SCAN IMG PET MYOCARDIAL PERFUSION MULTI STUDY IMG PET MYOCARDIAL PERFUSION SINGLE STUDY IMG PETCT AXUMIN SUBSQ TX IMG PETCT BRAIN ALZHEIMERS IMG PETCT BRAIN IMAGING METABOLIC IMG PETCT BRAIN SEIZURES IMG PETCT F18 BONE SCAN IMG PETCT GA68 DOTATATE INIT TX IMG PETCT GA68 DOTATATE SUBSQ TX IMG PETCT HEAD AND NECK INITIAL TX STRTGY IMG PETCT HEAD AND NECK SUBSQ TX STRTGY IMG PETCT LIMITED AREA IMG PETCT NEUROCEQ BRAIN IMAGING IMG PETCT SKULL TO THIGH INITIAL TX STRTGY IMG PETCT SKULL TO THIGH SUBSQ TX STRTGY IMG PETCT WHOLE BODY INITIAL TX STRTGY IMG PETCT WHOLE BODY SUBSQ TX STRTGY IMG QMRA CAROTID W WO INR IMG QMRA CAROTID WO INR IMG2325

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