Scope is a quality and safety-based program designed to protect patients by reducing unnecessary radiation, repeat studies, and missed diagnoses. The criteria consists of a comprehensive set of policy recommendations that improves safety and quality in image generation and interpretation by ensuring that certain radiologic services are performed and interpreted by trained physicians in accordance with the American Medical Association’s Green Book guidelines.

Why Scope

To allow health plans to track those providers with limited qualifications to render and interpret diagnostic imaging procedures outside their specialty scope, HealthHelp implemented the Scope quality program in 2013, which currently applies the broadest set of imaging procedure codes to entities that bill as multi-specialty groups. The Scope program helps health plans to limit providers billing outside of the imaging procedures assigned to their individual specialties regardless of their participation in “group practices.”

How Scope Works

Scope extends a specific set of imaging criteria to select non-radiologist providers on the basis of the criteria applicable to their particular medical specialty, as defined by board-certification or a certificate of completion of an accredited residence program in the specialty. Modalities included within the program oversight are CT, MRI, PET, cardiac nuclear medicine, bone densitometry, fluoroscopy, and ultrasound.Plain film is subject to specialty review.

Program Overview

  • Modalities include CT, MR, PET, nuclear medical studies, ultrasound, fluoroscopy, and bone densitometry.
  • Quality-and safety- focused to protect patients.
  • Reduces unnecessary radiation, repeat studies, misdiagnoses, and missed diagnoses.
  • Providers will only be reimbursed for imaging procedures listed on their permitted code lists and for procedures that the consideration process approves the provider to interpret.
  • Providers not affected by the program include those that have received proper training within the scope of their residencies, such as cardiologists and orthopedists.
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Please note: If you are communicating as a health plan member, please contact your healthcare provider. HealthHelp does not provide individual healthcare advice.