Prior Auth Required

30255 - 17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106
Procedure / Service Description

Site Clinical Services Survey Criteria (Continued) Yes No N/A wt - Site Clinical Services Survey Criteria (Continued) Yes No N/A wt E. Site meets CDPH Radiological inspection and safety regulations. 17 CCR §30110, §30111, §30255, §30305, §30404, §30405; https://www.cdph.ca.gov/rhb or (916) 327-5106 1. Site has current CA Radiologic Health Branch Inspection Report and Proof of Registration if there is radiological equipment on site. 1

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.