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Imaging Coding & Pre-Authorization Guide

The below files are to be used as a guide when referring patients for imaging services at the Outpatient Diagnostics Center or SampsonRMC.

MRI Coding Chart

CT Coding Chart

Pre-Authorization Chart for Diagnostic Procedures

The above pre-authorization chart is to be used as a guide.  It is best to verify authorization for all patients as each patient's policy requirements may vary.

Items Needed for Pre-Authorizations

Patient's Insurance ID Number

Ordering Provider's Name & Tax ID #

CPT Code of Requested Exam

Prior Labs, Exams, Treatment, etc.

Facility Information:  Sampson Regional Medical Center, 607 Beaman Street, Clinton, NC

NPI# 1609857432