To ensure our members are receiving the proper care, Providence Health Plan requires prior authorization for some procedures.

For your convenience, we have provided a list of CPT codes below, including diagnostic imaging, that require prior authorization along with the Providence Health Plan prior authorization fax form. For high tech diagnostic imaging Providence Health Plan has partnered with American Imaging Management to manage prior authorization requests. CPT codes that require prior authorization through AIM are listed both in the Providence prior authorization CPT code and AIM CPT groupings lists. Below is a list provided by AIM outlining specific CPT groupings along with FAQs and instructions on how to request a prior authorization.

• Providence prior authorization CPT code list – eff. 3/1/12 (PDF)
• Providence prior authorization CPT code list – eff. 1/1/12 (PDF)
• Providence prior authorization CPT code list – eff. 11/1/11 (PDF)
• Providence prior authorization CPT code list – eff. 9/1/11 (PDF)
• Providence prior authorization fax form (PDF)
• Transplant prior authorization form (PDF)

AIM resources

• AIM CPT groupings (2012) (PDF)
• AIM CPT groupings (PDF)
• AIM prior authorization FAQs (PDF)

The AIM Provider Portal is available 24 hours a day, seven days a week for real-time imaging requests and authorizations. Register today.

For registration: Providence Pin # is 045-83169

Prior authorization of diagnostic imaging is required before the performance of the study and is the responsibility of the ordering provider.

Find a list of our formulary and medical benefit drugs that need to be prior authorized and the form to do so on our Pharmacy page.

AIM Customer Service

800-920-1250
Monday through Friday, 8 a.m. to 5 p.m. (PST)

Providence Customer Service