CurrentAmerican Specialty HealthPolicy N/A

Spinal Ultrasound

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This policy governs coverage of spinal and paraspinal ultrasound for diagnosing selected conditions in newborns and infants and for intraoperative use during spinal or paraspinal surgery. It also identifies diagnostic spinal ultrasound uses that are not medically necessary, including evaluation of neuromusculoskeletal conditions and spinal pain or radiculopathy.

Policy Summary

PayerAmerican Specialty Health

PolicySpinal Ultrasound

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 15, 2026

Next Review DateSep 15, 2027

Key ActionFor neonatal or infant examinations, document the clinical indication supporting the ultrasound.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

<2 yearsNewborn and infant age

8Covered newborn and infant indications

3Listed medically necessary codes

3Not medically necessary use categories

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CurrentAmerican Specialty HealthPolicy N/A

Spinal Ultrasound

Customize your policy alerts

Sign up for all american_specialty_health policy alerts

Know when american_specialty_health releases new policies or updates existing guidance.

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Policy Summary

PayerAmerican Specialty Health

PolicySpinal Ultrasound

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 15, 2026

Next Review DateSep 15, 2027

Key ActionFor neonatal or infant examinations, document the clinical indication supporting the ultrasound.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

<2 yearsNewborn and infant age

8Covered newborn and infant indications

3Listed medically necessary codes

3Not medically necessary use categories

Intraoperative literature publications identified

Medical Necessity Criteria

Newborn and infant indications

Covered when the patient is younger than 2 years and any one of the following indications is present.

Newborn or infant indication

Covered indications
- Injury sequelae: Detection of sequelae of injury, including hematoma after birth injury, infection or hemorrhage, or post-traumatic leakage of cerebrospinal fluid.
- Tumors, vascular malformations, or birth-related trauma: Evaluation and diagnosis of suspected spinal cord tumors, vascular malformations, or birth-related trauma.
- Caudal regression syndrome: Evaluation of caudal regression syndrome, including anal atresia or stenosis or sacral agenesis.
- Lumbosacral stigmata: Evaluation of lumbosacral stigmata associated with spinal dysraphism, including an atypical deep sacral dimple greater than 5 mm in diameter and more than 2.5 cm from the anus.>5 mm and >2.5 cm from the anus
- Suspected spinal defects: Evaluation of suspected cord tethering, diastematomyelia, hydromyelia, or syringomyelia.
- Lumbar puncture guidance: Guidance for lumbar puncture.
- Postoperative cord assessment: Postoperative assessment for cord retethering.
- Blood products in the spinal canal: Visualization of fluid with characteristics of blood products within the spinal canal in a neonate or infant with intracranial hemorrhage.

Intraoperative use

Covered when used during spinal or paraspinal surgery.

Intraoperative use: Spinal and/or paraspinal ultrasound is medically necessary when used during spinal or paraspinal surgery.

Not medically necessary diagnostic uses

Diagnostic spinal or paraspinal ultrasound is not medically necessary for the following uses.

Excluded diagnostic uses: Diagnostic ultrasound of the spine and/or paraspinal tissues is not medically necessary for evaluation of neuromusculoskeletal conditions, including intervertebral discs, facet joints and capsules, central nerves, fascial edema, paraspinous abnormalities, pain or radiculopathy syndromes, or monitoring of therapy; for diagnosis and management of spinal pain or radiculopathy; or for rehabilitation of neuromusculoskeletal disorders and back pain.

These uses are explicitly excluded from medical necessity.

Newborn and infant spinal ultrasound

Spinal ultrasound in newborns and infants is supported when clinically indicated by one or more of the following conditions.

Neonatal and infant indications: One or more of the following clinical indications is present: lumbosacral stigmata associated with spinal dysraphism or tethered cord; caudal regression syndrome or associated anorectal malformations; suspected cord tethering, diastematomyelia, hydromyelia, or syringomyelia; hematoma, infection, hemorrhage, or post-traumatic cerebrospinal fluid leakage; blood products in the spinal canal in an infant with intracranial hemorrhage; lumbar puncture guidance; postoperative assessment for cord tethering; or suspected congenital spinal tumor, such as sacrococcygeal teratoma.

Intraoperative spinal ultrasound

Intraoperative spinal ultrasound may be useful in selected spine surgery.

Selected intraoperative applications: Intraoperative ultrasound is used to assist visualization or decompression during spine surgery, including decompression of degenerative disease in any spinal region, thoracic decompression of fractures, or lumbar decompression of nerve roots.

The policy describes these as selected surgical applications supported by the reviewed evidence.

Adult nonoperative diagnostic spinal ultrasound

Routine nonoperative diagnostic spinal ultrasound in adults is not supported by the available evidence.

Adult diagnostic applications lacking support: Adult nonoperative diagnostic ultrasound for back pain, radicular symptoms, spinal or paraspinal conditions, intervertebral discs, facet joints, central nerves, spinal stenosis, disc herniation, nerve-root pathology, treatment response, or disease progression is investigational or cannot be recommended because of insufficient evidence or lack of proven clinical utility.

Ultrasound may be used as guidance for certain spinal injections, but that does not establish diagnostic coverage for the underlying spinal condition.

Diagnostic ultrasound of the spine and/or paraspinal tissues is not medically necessary for evaluating neuromusculoskeletal conditions, including the intervertebral discs, facet joints and capsules, central nerves, fascial edema, paraspinous abnormalities, pain syndromes, radiculopathy syndromes, or for monitoring therapy.

Diagnostic ultrasound is not medically necessary for the diagnosis or management of spinal pain and radiculopathy.

Diagnostic ultrasound is not medically necessary when used to guide rehabilitation of neuromusculoskeletal disorders or back pain.

Preoperative spinal ultrasound is contraindicated in patients with open spinal dysraphism.

Examination of the contents of a closed neural tube defect is contraindicated when the overlying skin is thin or no longer intact.

Diagnostic ultrasound of the spine and/or paraspinal tissues is considered not medically necessary for any indication other than the covered newborn or infant indications and intraoperative spinal or paraspinal surgical use.

Routine nonoperative diagnostic spinal or paraspinal ultrasound in adults is not supported by published evidence for nonspecific low back pain, radicular symptoms, disc herniation, spinal stenosis, nerve-root pathology, or evaluation of the spine and paraspinal tissues. The available evidence does not establish reliable diagnostic accuracy, clinical utility, or improvement in treatment planning.

Ultrasound is not suggested as a routine diagnostic modality for adult spinal screening, monitoring treatment response, or assessing disease progression in inflammatory back pain or suspected axial spondyloarthropathy because of a lack of proven diagnostic utility.

Covered Clinical Indications

Newborn and infant evaluation

Covered indications for newborn and infant evaluation include any one of the following.

Newborn or infant evaluation

Covered indications: At least one of the following is present: injury sequelae; suspected spinal cord tumor, vascular malformation, or birth-related trauma; caudal regression syndrome; lumbosacral stigmata associated with spinal dysraphism; suspected spinal defect; need for lumbar puncture guidance; postoperative cord retethering assessment; or fluid with characteristics of blood products in the spinal canal with intracranial hemorrhage.

Intraoperative visualization or guidance during spinal or paraspinal surgery

Covered when performed during spinal or paraspinal surgery.

Intraoperative visualization or guidance: Spinal and/or paraspinal ultrasound is used during spinal or paraspinal surgery for visualization or guidance.

Coding and Threshold Reference

Covered CPT CodesCPTCovered

62270	Spinal puncture, lumbar, diagnostic
76800	Ultrasound, spinal canal and contents
76942	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

Newborn and infant age

Age thresholdUnder 2 years of age

Patient groupNewborns and infants

Covered useSpinal and/or paraspinal ultrasound when a listed covered indication is present

Atypical sacral dimple diameter

Diameter thresholdGreater than 5 mm (greater than 0.5 cm)

Clinical descriptionDeep and large atypical sacral dimple

SignificanceAssociated with a high risk of occult spinal dysraphism

Documentation, Billing, and Denial Prevention

Billing Rule

Use Current, Appropriate Codes

Submit the most appropriate diagnosis and procedure code(s) that are effective on the submission date. Code updates may occur more frequently than this policy, and deleted or not-yet-effective codes may not be eligible for reimbursement.

Use the code(s) effective when the service is rendered and submitted.
Confirm coding against current AMA and CMS updates.

Documentation Required

Document the Infant Indication

Document the neonatal or infant clinical indication for spinal ultrasound, including the suspected abnormality, relevant examination findings, or other reason for the study.

Clinical Background

Diagnostic ultrasound uses sound waves to create images and does not involve ionizing radiation. The policy supports spinal or paraspinal ultrasound in newborns and infants, whose posterior spinal elements are sufficiently membranous for visualization, and for selected intraoperative spine applications. Intraoperative use may assist with visualization and decompression, while infant examinations may evaluate suspected congenital or acquired abnormalities. If an infant study is abnormal, equivocal, or technically limited, MRI is advised for complete assessment.

Terms and Abbreviations

Diagnostic ultrasound (DUS)

Also calledSonography or ultrasonography

How it worksUses sound waves to create images of bodily tissues

Clinical descriptionAn operator-dependent imaging modality requiring knowledge of three-dimensional anatomy and appropriate transducer frequency and orientation

Spinal dysraphism

DefinitionA spectrum of congenital disorders of the central nervous system

ExamplesMyelocele, meningocele, myelomeningocele, and spina bifida

Related findings

Excluded Services and Uses

The policy does not cover diagnostic ultrasound of the spine or paraspinal tissues for neuromusculoskeletal conditions, spinal pain or radiculopathy, or rehabilitation of neuromusculoskeletal disorders and back pain. Routine adult nonoperative examinations—including evaluation of disc disease, disc herniation, spinal stenosis, nerve-root pathology, facet joints, central nerves, screening, treatment response, or disease progression—are not medically necessary or lack sufficient clinical support.

Policy Summary

PayerAmerican Specialty Health

PolicySpinal Ultrasound

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 15, 2026

Next Review DateSep 15, 2027

Key ActionFor neonatal or infant examinations, document the clinical indication supporting the ultrasound.

SourceLink

On This Page

Evaluation of suspected congenital or acquired spinal abnormalities in newborns and infants

For newborns and infants, ultrasound is supported when one or more suspected congenital or acquired abnormalities or related clinical indications is present.

Congenital or acquired spinal abnormalities: The evaluation concerns lumbosacral stigmata associated with spinal dysraphism or tethered cord; caudal regression syndrome or associated anorectal malformations; suspected cord tethering, diastematomyelia, hydromyelia, or syringomyelia; acquired injury or post-instrumentation complications such as hematoma, infection, hemorrhage, or post-traumatic cerebrospinal fluid leakage; blood products in the spinal canal with intracranial hemorrhage; lumbar puncture guidance; postoperative cord tethering; or a suspected congenital spinal tumor such as sacrococcygeal teratoma.

Intraoperative visualization and guidance during spine surgery

Intraoperative ultrasound is supported for selected visualization and guidance applications during spine surgery.

Selected spine-surgery uses: Use for spinal decompression for degenerative disease in any spinal region, thoracic decompression of fractures, or lumbar decompression of nerve roots.

The reviewed literature describes intraoperative ultrasound as useful for these selected applications.

Atypical sacral dimple location

Location thresholdMore than 2.5 cm above the anus

Clinical descriptionAtypical sacral dimple location

Associated concernMay be associated with occult spinal dysraphism, particularly with other cutaneous stigmata

Simple sacral midline dimple

DiameterLess than 5 mm

LocationWithin 2.5 cm of the anus

Other characteristicsOverlies the coccyx and has a visible intact base

Usual significanceGenerally benign; spinal ultrasound is generally not needed for this finding alone

Lumbosacral stigmata associated with spinal dysraphism or tethered cord, such as masses, discoloration, skin tags, hair tufts, hemangiomas, atypical sacral dimples, or deep paramedian dimples.
Caudal regression syndrome, including sacral agenesis and anorectal malformations.
Suspected cord tethering, diastematomyelia, hydromyelia, syringomyelia, congenital spine tumors, or other spinal abnormalities.
Acquired abnormalities or complications, including hematoma, infection, hemorrhage, post-traumatic CSF leakage, or blood products in the spinal canal.
Guidance for lumbar puncture or postoperative assessment for cord tethering.

Note

Follow Up Abnormal or Limited Infant Studies

Use spinal ultrasound as a first-line screening examination in appropriate neonates and young infants, but obtain MRI for full assessment when the ultrasound is abnormal, equivocal, or technically limited.

Document the ultrasound findings and the reason additional imaging is needed.
MRI is advised when ultrasound does not adequately characterize the suspected abnormality.

Denial Risk

Use Covered Diagnoses and Procedure Codes

Reimbursement requires submission in accordance with the policy, including covered diagnosis and procedure code(s). Claims may be denied when the service is billed for a noncovered condition or is submitted without covered code(s).

Use a diagnosis that is covered under the policy and supported by the medical record.
Do not bill the service for conditions or diagnoses that are not covered.
The applicable benefit plan document and the facts of the individual case ultimately determine coverage.

Denial Risk

Avoid Excluded Diagnostic Indications

Diagnostic ultrasound of the spine or paraspinal tissues is not medically necessary for neuromusculoskeletal, pain, or rehabilitation indications outside the supported uses described in the policy.

Do not use it to evaluate intervertebral discs, facet joints or capsules, central nerves, fascial edema, paraspinous abnormalities, pain, or radiculopathy syndromes.
Do not use it for diagnosis or management of spinal pain or radiculopathy.
Do not use it to guide rehabilitation of neuromusculoskeletal disorders or back pain or to monitor therapy.

Denial Risk

Adult Diagnostic Spinal Ultrasound Lacks Support

Routine nonoperative diagnostic spinal or paraspinal ultrasound in adults lacks adequate clinical support and is not supported for broad adult diagnostic use. It should not replace established diagnostic procedures such as MRI or CT.

Evidence is insufficient for diagnostic evaluation, screening, or therapy monitoring involving adult intervertebral discs, facet joints and capsules, central nerves, or paraspinal tissues.
Adult use for back pain, radicular symptoms, disc herniation, spinal stenosis, nerve-root pathology, or routine low-back-pain evaluation is not supported.
Ultrasound may be used for certain spinal injection guidance and has distinct intraoperative or neonatal/infant applications; these do not establish support for routine adult diagnostic use.

Denial Risk

Inflammatory Back Pain or Axial Spondyloarthropathy

For inflammatory back pain or suspected axial spondyloarthropathy, do not use ultrasound routinely for diagnosis, assessment of treatment response, or evaluation of disease progression because diagnostic utility is lacking.

Use an imaging modality supported by the applicable clinical scenario and appropriateness criteria.

Denial Risk

Observe Neonatal Contraindications

Do not perform neonatal spinal ultrasound in the specified contraindicated circumstances.

Do not perform a preoperative examination in a patient with open spinal dysraphism.
Do not examine the contents of a closed neural tube defect when the overlying skin is thin or no longer intact.

May be associated with anorectal or urogenital malformations and cutaneous markers such as atypical dimples, skin tags, tails, hemangiomas, or hairy patches

Simple sacral midline dimple

LocationOver the coccyx

BaseVisible and intact

SizeLess than 5 mm in diameter

Distance from anusWithin 2.5 cm of the anus

IOUS

AbbreviationIOUS

DefinitionIntraoperative ultrasound used during spine surgery

UsesAssesses decompression and visualizes spinal structures

Selected applicationsDecompression of degenerative cases in all spinal regions, thoracic fracture decompression, and lumbar nerve-root decompression

OSD

AbbreviationOSD

DefinitionOccult spinal dysraphism, a group of spinal developmental abnormalities

Associated conditionMay be associated with tethered cord

Characteristic findingsMay present with lumbosacral cutaneous findings, including atypical dimples, skin tags, hair tufts, hemangiomas, or other stigmata

DUS

AbbreviationDUS

Anatomic scopeDiagnostic ultrasound of the spine or paraspinal tissues

Typical contextParticularly considered in adults and outside the operative setting

Evidence statusNonoperative diagnostic use in adults for intervertebral disks, facet joints and capsules, or central nerves has insufficient evidence and no proven clinical utility