CurrentAetnaPolicy 0093

Open Air, Low Field Strength, and Positional Magnetic Resonance Imaging (MRI) Units

Defines Aetna's coverage stance for MRI imaging performed with open, low-field, and positional/upright (including stand-up and weight-bearing) MRI units, including which uses are considered medically necessary and which are experimental/investigational.

Policy Summary

PayerAetna

PolicyOpen Air, Low Field Strength, and Positional Magnetic Resonance Imaging (MRI) Units

Policy CodePolicy 0093

Change TypeNo material change

Effective DateJan 12, 1996

Next Review DateJan 25, 2024

Key ActionDocument clinical indication for MRI; field strength/configuration does not alter medical necessity determination when standard indications are present.

SourceLink

POLICY UPDATE CHANGES

There are no material clinical or coverage changes in this update; the policy continues to state that low-field and open MRI units are acceptable alternatives and repeat positional/weight-bearing MRI is considered investigational.

CoveredCovered when standard indications met regardless of field strength/configuration

Not coveredRepeat positional/weight-bearing MRI considered investigational/not covered

S8042HCPCS low-field MRI code noted (S8042)

Coverage Summary

Policy Number 0093 — Current status: CURRENT. This policy defines Aetna's scope for MRI imaging performed with open, low-field, and positional/upright (including stand-up and weight-bearing) MRI units. Effective date: 1996-01-12. Last review: 2023-03-21. Next review: 2024-01-25.