Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) X-ray Hip Unilateral with Pelvis (1 view) prior authorization requirements (2026)
What Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) generally requires to approve X-ray Hip Unilateral with Pelvis (1 view) (CPT 73501), for Auto No-Fault (NJ PIP) plans. Based on the cited policy, Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) does not generally require prior authorization for X-ray Hip Unilateral with Pelvis (1 view) (CPT 73501). Confirm with Plymouth Rock (High Point, Palisades, Teachers, Twin Lights), as this can vary by plan.
Medical-necessity criteria Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) 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 732-978-7100 (phone 888-814-6397)
- Portal: Plymouth Rock
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 X-ray Hip Unilateral with Pelvis (1 view)?
Based on the cited policy, Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) does not generally require prior authorization for X-ray Hip Unilateral with Pelvis (1 view) (CPT 73501). Confirm with Plymouth Rock (High Point, Palisades, Teachers, Twin Lights), as this can vary by plan.
What does Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) require to approve X-ray Hip Unilateral with Pelvis (1 view)?
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 Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) policy.
How long does a Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) prior authorization take?
Turnaround varies by plan and submission method. Check the Plymouth Rock (High Point, Palisades, Teachers, Twin Lights) portal for current timeframes.
Submitting X-ray Hip Unilateral with Pelvis (1 view) 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.