Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) CT Head/Brain without and with contrast prior authorization requirements (2026)
What Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) generally requires to approve CT Head/Brain without and with contrast (CPT 70470), for Auto No-Fault (NJ PIP) plans. Yes. Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) generally requires prior authorization for CT Head/Brain without and with contrast (CPT 70470).
Medical-necessity criteria Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) generally applies
Decision point review (DPR) required: CT is on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so the determination to administer it is a decision point for ALL injuries, not just Care Path injuries (11:3-4.5(d)). No DPR or precertification applies to emergency care or within 10 days of the accident (11:3-4.7(b)) - medical necessity and causation still apply. Submit the DOBI Uniform APTP form with clinically supported findings from a personal examination; the carrier must respond within 3 business days (11:3-4.7(c)4), and under DOBI-approved plans treatment is deemed authorized until a determination issues if it fails to respond timely. Failure to request DPR where required risks a co-payment penalty of up to 50% of the eligible charge (11:3-4.4(e)); using a non-network facility where the plan has an approved voluntary network for CT can add a penalty of up to 30% (11:3-4.4(g), 11:3-4.8(b)).
Commonly required documentation
- DOBI Uniform Attending Provider Treatment Plan (APTP) form ver. 16.03.10 (nj.gov/dobi/pipinfo/aptp_ver160310.pdf) - patient name/DOB, claim number, date of accident, ICD-10 codes, each CPT code with frequency/duration, provider signature
- clinically supported findings from a personal physical examination
- relevant progress notes and prior imaging/test results. Incomplete APTPs are denied as deficient.
How to submit
- Method: Fax APTP 732-978-7100 (phone 888-814-6397)
- Portal: Plymouth Rock
- Typical turnaround: about 3 days
Sources & verification
NJ PIP (auto no-fault). Sources: N.J.A.C. 11:3-4 (eff. 10/16/2017), carrier DPRP: https://www.plymouthrock.com/public/Plymouthrock/StaticFiles/PDF/Decision-Point-Review-Plan-edition-PRA-NJ-203-04-22.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. Includes High Point, Palisades, Teachers, Twin Lights. Post-service appeals fax 732-978-6320. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) require prior authorization for CT Head/Brain without and with contrast?
Yes. Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) generally requires prior authorization for CT Head/Brain without and with contrast (CPT 70470).
What does Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) require to approve CT Head/Brain without and with contrast?
Decision point review (DPR) required: CT is on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so the determination to administer it is a decision point for ALL injuries, not just Care Path injuries (11:3-4.5(d)). No DPR or precertification applies to emergency care or within 10 days of the accident (11:3-4.7(b)) - medical necessity and causation still apply. Submit the DOBI Uniform APTP form with … Always confirm against the current Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) policy.
How long does a Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) prior authorization take?
Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) typically decides CT Head/Brain without and with contrast requests in about 3 days. Timeframes vary; check the payer portal.
Submitting CT Head/Brain without and with contrast to Plymouth Rock (High Point, Palisades, Teachers, Twin Lights)?
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.