Louisiana Healthcare Connections Policies and Procedures Updates - NIA Policies
Date: 12/15/23
Louisiana Healthcare Connections is sharing with providers the below policies and procedures that were developed by NIA and/or revised; posted for public comment and approved by LDH in accordance with La. R.S. 46:460.54. Non-material revisions do not require LDH approvals.
Please share this notice with other members of your practice and office staff as necessary.
These guidelines will be implemented 30 days from the date of this notice and will be posted on NIA’s website.
Policy & Procedure # | Policy & Procedure Title |
|---|
NIA_CG_001 | Brain (Head) MRI/Brain (Head) MRI w IAC (Internal Auditory Canal) |
NIA_CG_002 | Brain (Head) CT |
NIA_CG_003 | Brain (Head) MRS |
NIA_CG_004-1 | Brain (Head) CTA |
NIA_CG_004-2 | Brain (Head) MRA/MRV |
NIA_CG_006 - 1 | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal CT |
NIA_CG_007 | Temporomandibular Joint (TMJ) MRI |
NIA_CG_008-1 | Neck CT (soft tissue) |
NIA_CG_009 | Sinus & Maxillofacial CT limited or localized f/u Sinus CT |
NIA_CG_012-1 | Neck CTA |
NIA_CG_012-2 | Neck MRA/MRV |
NIA_CG_013 | Functional Brain MRI |
NIA_CG_014 | Sinus, Face, Orbit, Neck, and IAC MRI |
NIA_CG_015 | Cerebral Perfusion CT |
NIA_CG_020 | Chest (Thorax) CT |
NIA_CG_020-1 | Low Dose CT for Lung Cancer Screening |
NIA_CG_021 | Chest (Thorax) MRI |
NIA_CG_022-1 | Chest CTA |
NIA_CG_022-2 | Chest MRA/MRV |
NIA_CG_023 | Breast MRI |
NIA_CG_024 | Myocardial Perfusion Imaging (Nuclear Cardiac Imaging Study) |
NIA_CG_025 | Heart CT Congenital |
NIA_CG_026 | Stress Echocardiography |
NIA_CG_027 | MUGA (Multiple Gated Acquisition) Scan |
NIA_CG_028 | Heart MRI |
NIA_CG_029 | Coronary Artery Calcium Scoring by: EBCT or Non-Contrast CCT |
NIA_CG_030 | Abdomen CT |
NIA_CG_031 | Abdomen MRI MRCP MRE MRU |
NIA_CG_033-1 | CT (VIRTUAL) COLONOSCOPY DIAGNOSTIC |
NIA_CG_033-2 | CT (Virtual) Colonoscopy – Screening |
NIA_CG_034-1 | ABDOMEN CTA (Angiography) |
NIA_CG_034-2 | Abdomen MRA/MRV (Angiography) |
NIA_CG_035 | CTA Aortogram with Runoff |
NIA_CG_036 | Pelvis CT |
NIA_CG_037 | Pelvis MRI |
NIA_CG_038 | Pelvis CTA Angiography |
NIA_CG_039 | Pelvis MRA/MRV |
NIA_CG_040 | Cervical Spine MRI |
NIA_CG_041 | Cervical Spine CT |
NIA_CG_042 | Thoracic Spine MRI |
NIA_CG_043 | Thoracic Spine CT |
NIA_CG_044 | Lumbar Spine MRI |
NIA_CG_045 | Lumbar Spine CT |
NIA_CG_046 | Spinal Canal MRA/MRV |
NIA_CG_057-1 | Upper Extremity CT (Hand, Wrist, Long bone, or Shoulder CT) |
NIA_CG_057-2 | Lower Extremity CT (foot, ankle, leg or hip CT) |
NIA_CG_057-3 | Upper Extremity MRI (Hand, Wrist, Elbow, Long bone, or Shoulder MRI) |
NIA_CG_057-4 | Lower Extremity MRI |
NIA_CG_058-1 | Lower Extremity MRA/MRV |
NIA_CG_058-2 | Upper Extremity MRA/MRV |
NIA_CG_059 | Bone Marrow MRI |
NIA_CG_060-2 | CT Bone Density Study |
NIA_CG_061-1 | Lower Extremity CTA/CTV |
NIA_CG_061-2 | Upper Extremity CTA/CTV |
NIA_CG_062 | CT Coronary Angiography (CCTA) |
NIA_CG_063 | Unlisted Studies |
NIA_CG_065 | Heart Catheterization |
NIA_CG_067 | Transthoracic (TTE) Echo |
NIA_CG_068 | Abdomen/Pelvis CT Combo |
NIA_CG_069 | Abdomen/Pelvis CTA |
NIA_CG_070-1 | PET Scans |
NIA_CG_071 | Brain PET Scan |
NIA_CG_078 | Single Photon Emission Computed Tomography SPECT |
NIA_CG_079 | Heart PET with CT Attenuation |
NIA_CG_110 | Fetal MRI |
NIA_CG_301 | Paravertebral Facet Joint Injections or Blocks |
NIA_CG_302 | Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis) |
NIA_CG_304 | LUMBAR SPINE SURGERY |
NIA_CG_304-1 | LUMBAR ARTIFICIAL DISC REPLACEMENT |
NIA_CG_305 | Sacroiliac Joint Injections |
NIA_CG_310 | Implantable Infusion Pump Insertion |
NIA_CG_315 | KNEE ARTHROPLASTY |
NIA_CG_316 | KNEE ARTHROSCOPY |
NIA_CG_317 | SHOULDER ARTHROPLASTY |
NIA_CG_318 | SHOULDER ARTHROSCOPY |
NIA_CG_320 | Cardiac Resynchronization Therapy (CRT) |
NIA_CG_404 | Sympathetic Nerve Block |
NIA_CG_405 | Spinal Cord Stimulation |
NIA_CG_407 | SACROILIAC JOINT FUSION |
NIA_CG_408 | Epidural Spine Injections and Single Trials for Intrathecal Pumps |
NIA_CG_602 | Outpatient Habilitative and Rehabilitative Speech Therapy |
NIA_CG_603 | Outpatient Habilitative Physical and Occupational Therapy |
NIA_CG_604 | Passive Treatment |
NIA_CG_605 | Measurable Progressive Improvement |