NJM X-ray Hip Unilateral with Pelvis (2-3 views) prior authorization requirements (2026)
What NJM generally requires to approve X-ray Hip Unilateral with Pelvis (2-3 views) (CPT 73502), for Auto No-Fault (NJ PIP) plans. Based on the cited policy, NJM does not generally require prior authorization for X-ray Hip Unilateral with Pelvis (2-3 views) (CPT 73502). Confirm with NJM, as this can vary by plan.
Medical-necessity criteria NJM generally applies
Plain-film x-rays are NOT on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so decision point review is not required by the regulation, and no DPR or precertification requirement applies within 10 days of the accident or to emergency care (11:3-4.7(b)). The carrier decision point review plans reviewed in 2026 did not add plain radiographs to their precertification lists, but the carrier's DOBI-approved plan governs - verify against the current plan before relying on this. Only medically necessary, accident-related care is reimbursable: document the accident mechanism, date of accident, and clinically supported findings from a personal examination.
Commonly required documentation
- None required by the regulation outside the carrier's approved plan. If the carrier's plan requires notice, use the DOBI Uniform APTP form (ver. 16.03.10, nj.gov/dobi/pipinfo/aptp_ver160310.pdf). Document accident mechanism, date of accident, claim number, and exam findings in the note.
How to submit
- Method: Fax APTP to assigned NJM PIP Claims Rep - W. Trenton 609-493-1277 / Parsippany 609-493-1565 / Hammonton 609-493-1474 (OSSNJ table)
- Portal: NJM PIP Rep
Sources & verification
NJ PIP (auto no-fault). Sources: N.J.A.C. 11:3-4 (eff. 10/16/2017), carrier DPRP: https://www.njm.com/-/media/pdf/decision-point-review-plan-requirements-ac-pip-19.pdf; OSSNJ no-fault pre-cert reference table (photographed 2026-06-25). Internal appeal required before PIP arbitration (11:3-4.7B): pre-service within 30 days of denial (decision due 14 days), post-service at least 45 days before ADR (decision due 30 days), on DOBI uniform appeal forms. IME: must be scheduled within 7 calendar days, same-discipline examiner, decision 3 business days after exam (11:3-4.7(e)). Statewide facts verified 2026-07-09. NJM plan requires re-notification every 28 days for continued treatment of non-identified injuries absent an approved comprehensive treatment plan. Post-service appeals fax 609-963-6075 only. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does NJM require prior authorization for X-ray Hip Unilateral with Pelvis (2-3 views)?
Based on the cited policy, NJM does not generally require prior authorization for X-ray Hip Unilateral with Pelvis (2-3 views) (CPT 73502). Confirm with NJM, as this can vary by plan.
What does NJM require to approve X-ray Hip Unilateral with Pelvis (2-3 views)?
Plain-film x-rays are NOT on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so decision point review is not required by the regulation, and no DPR or precertification requirement applies within 10 days of the accident or to emergency care (11:3-4.7(b)). The carrier decision point review plans reviewed in 2026 did not add plain radiographs to their precertification lists, but the carrier's DOBI-app… Always confirm against the current NJM policy.
How long does a NJM prior authorization take?
Turnaround varies by plan and submission method. Check the NJM portal for current timeframes.
Submitting X-ray Hip Unilateral with Pelvis (2-3 views) to NJM?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.