Louisiana Healthcare Connections Policies and Procedures Updates
Date: 03/24/26
Louisiana Healthcare Connections is sharing with providers the below policies and procedures that were developed 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 our Through NIA’s Website at www.RadMD.com.
Policy ID | Policy & Procedure Title |
Evolent_CG_2000 | Abdomen Pelvis (CT) |
Evolent_CG_2001 | Abdomen Computed Tomography (CT) |
Evolent_CG_2002 | Abdomen Computed Tomography Angiography (CTA) |
Evolent_CG_2003 | Abdomen Magnetic Resonance Angiography (MRA) |
Evolent_CG_2004 | Abdomen Magnetic Resonance Imaging (MRI) with or without Magnetic Resonance Cholangiopiopancreatography (MRCP) |
Evolent_CG_2005 | Abdomen Pelvis Computed Tomography Angiography (CTA) |
Evolent_CG_2006 | Abdominal Aorta Computed Tomography Angiography with Lower Extremity Runoff |
Evolent_CG_2007 | Bone Marrow Magnetic Resonance Imaging (MRI) |
Evolent_CG_2008 | Brian Computed Tomography (CT) |
Evolent_CG_2009 | Brain Computed Tomography Angiography (CTA) |
Evolent_CG_2010 | Magnetic Resonance Spectroscopy (MRS) |
Evolent_CG_2011 | Brain Magnetic Resonance Angiography (MRA) |
Evolent_CG_2012 | Brain Magnetic Resonance Imaging (MRI) with or without Internal Auditory Canal (IAC) Views |
Evolent_CG_2013 | Brain Positron Emission Tomography (PET) Scan |
Evolent_CG_2014 | Breast Magnetic Resonance Imaging (MRI) |
Evolent_CG_2015 | Cerebral Perfusion Computed Tomography (CT) |
Evolent_CG_2016 | Cervical Spine Computed Tomography (CT) |
Evolent_CG_2017 | Cervical Spine Magnetic Resonance Imaging (MRI) |
Evolent_CG_2018 | Chest Computed Tomography (CT) |
Evolent_CG_2019 | Chest Magnetic Resonance Imaging (MRI) |
Evolent_CG_2020 | Chest Computed Tomography Angiography (CTA) |
Evolent_CG_2021 | Chest Magnetic Resonance Angiography (MRA) |
Evolent_CG_2022 | Computed Tomography (CT) (Virtual) Colonscopy-Diagnostic |
Evolent_CG_2023 | Computed Tomography (CT) (Virtual) Colonscopy-Screening |
Evolent_CG_2024 | Computed Tomography (CT) Bone Density Study |
Evolent_CG_2027 | Fetal Magnetic Resonance Imaging (MRI) |
Evolent_CG_2028 | Functional Magnetic Resonance Imaging (MRI) Brain |
Evolent_CG_2030 | Low Dose Computed Tomography (CT) for Lung Cancer Screening |
Evolent_CG_2031 | Low Field Magnetic Resonance Imaging (MRI) |
Evolent_CG_2032 | Lower Extremity Computed Tomography (CT) Ankle, Foot, Hip, Knee, Leg, Lower Extremity |
Evolent_CG_2034 | Lower Extremity Magnetic Resonance Angiography (MRA) Ankle, Lower Extremity |
Evolent_CG_2033 | Lower Extremity Computed Tomography Angiography (CTA) |
Evolent_CG_2035 | Lower Extremity Magnetic Resonance Imaging (MRI) Ankle, Foot, Hip, Knee, Lower Extremity |
Evolent_CG_2036 | Lumbar Spine Computed Tomography (CT) |
Evolent_CG_2037 | Lumbar Spine Magnetic Resonance Imaging (MRI) |
Evolent_CG_2039 | Neck Computed Tomography (CT) |
Evolent_CG_2040 | Neck Computed Tomography Angiography (CTA) |
Evolent_CG_2041 | Neck Magnetic Resonance Angiography (MRA)- |
Evolent_CG_2042 | Pelvis Computed Tomography (CT) |
Evolent_CG_2043 | Pelvis Computed Tomography Angiography (CTA) |
Evolent_CG_2044 | Pelvis Magnetic Resonance Angiography (MRA) |
Evolent_CG_2045 | Pelvis Magnetic Resonance Imaging (MRI) |
Evolent_CG_2046 | Positron Emission Tomography (PET) Scan, PET Scan with Computed Tomography (CT) for Attenuation |
Evolent_CG_2047 | Sinus Maxillofacial Computed Tomography (CT |
Evolent_CG_2048 | Sinus, Face, Orbit, Neck, and Internal Auditory Canal Magnetic Resonance Imaging (MRI) |
Evolent_CG_2053 | Spinal Canal Magnetic Resonance Angiography (MRA) |
Evolent_CG_2054 | Temporal Bone, Mastoid, Orbits, Sella, Internal Auditory Canal Computed Tomography (CT) |
Evolent_CG_2055 | Temporomandibular Joint (TMJ) Magnetic Resonance Imaging (MRI) |
Evolent_CG_2056 | Thoracic Spine Computed Tomography (CT) |
Evolent_CG_2057 | Thoracic Spine Magnetic Resonance Imaging (MRI) |
Evolent_CG_2061 | Unlisted Study |
Evolent_CG_2062 | Upper Extremity Computed Tomography (CT) Arm, Carpal Joint, Hand, Scapula, Shoulder, Upper Extremity, Wrist |
Evolent_CG_2063 | Upper Extremity Computed Tomography Angiography (CTA) |
Evolent_CG_2064 | Upper Extremity Magnetic Resonance Angiography (MRA) |
Evolent_CG_2065 | Upper Extremity Magnetic Resonance Imaging (MRI), Arm, Carpal Joint, Elbow, Hand, Humerus, Scapula, Shoulder, Upper Extremity Joint, Upper Extremity Non-Joint, Wrist |
Evolent_CG_7263 | Cardiac Resynchronization Therapy |
Evolent_CG_7272 | Coronary Artery Calcium Scoring by Electron Beam Computed Tomography (EBCT) or Non-Contrast Coronary Computed Tomography (CCT) |
Evolent_CG_7275 | Coronary Artery Computed Tomography Angiography (CCTA) |
Evolent_CG_7294 | Heart Positron Emission Tomography (PET) Scan |
Evolent_CG_7295 | Heart Catheterization |
Evolent_CG_7296 | Heart Computed Tomography (CT) Structure and Morphology, Congenital Studies |
Evolent_CG_7297 | Heart Magnetic Resonance Imaging (MRI) |
Evolent_CG_7298 | Heart Positron Emission Tomography (PET) with Computed Tomography (CT) for Attenuation |
Evolent_CG_7301 | Implantable Cardioverter Defibrillator |
Evolent_CG_7311 | Multiple Gated Acquisition Scan (MUGA) |
Evolent_CG_7312 | Myocardial Perfusion Imaging (MPI) |
Evolent_CG_7315 | Pacemaker Insertion |
Evolent_CG_7328 | Stress Echocardiogram |
Evolent_CG_7336 | Transesophageal Echocardiogram (TEE) |
Evolent_CG_7337 | Transthoracic Echocardiogram (TTE) |