Magnetic Resonance Imaging–Guided Focused Ultrasound (MRgFUS) coverage criteria
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Defines medical coverage, coding, and prior authorization requirements for MR-guided high-intensity focused ultrasound ablation for Medicare Advantage and Commercial products, including indications considered medically necessary and those considered not covered or not medically necessary.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medically Necessary Indications (Medicare Advantage and Commercial when criteria met)
May be considered medically necessary when the medical criteria in the online authorization tool for participating providers is met for the following procedure codes:
Not Covered / Not Medically Necessary Indications
Considered not covered or not medically necessary in other situations, including:
Magnetic resonance–guided focused ultrasound (MRgFUS) is not covered / not medically necessary for indications beyond those specifically listed as potentially medically necessary in this policy. Medicare Advantage Plans and Commercial Products require that treatment meet the medical criteria in the payer's online authorization tool for the codes designated as potentially medically necessary; other uses of MRgFUS are considered not covered or not medically necessary because the evidence is insufficient to demonstrate improvement in net health outcomes.
The CPT codes 0071T and 0072T—which describe focused ultrasound ablation of uterine leiomyomata (volume thresholds reflected in the code descriptors)—are designated not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. Providers submitting claims for treatment of uterine leiomyomata should not use 0071T or 0072T for members covered under these products, as such claims are subject to denial under this policy.
FDA-Approved and Potentially Covered Indications
FDA-approved and potentially covered indications
Policy specifies codes and coverage stance; see coding and prior authorization modules
Coding and Billing
| 61715 | Magnetic resonance image guided high intensity focused ultrasound (mrgfus), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed |
| C9734 | Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance |
Provider Actions & Billing Guidance
Prior authorization required (Medicare Advantage); recommended (Commercial)
Prior authorization is required for magnetic resonance–guided high‑intensity ultrasound ablation (CPT 61715, HCPCS C9734) for Medicare Advantage Plans and is recommended for Commercial Products; authorizations are obtained via the payer's online authorization tool for participating providers.
Verify member benefits and coverage
Verify benefits and coverage before scheduling treatment by reviewing the member’s Evidence of Coverage or Subscriber Agreement, since benefits may vary by group/contract.
Obtain prior authorization via online portal
Obtain prior authorization through the payer's online portal when submitting CPT code 61715 or HCPCS code C9734 for MR‑guided high‑intensity ultrasound ablation; this is required for Medicare Advantage and recommended for Commercial Products.
Uterine fibroid CPT codes 0071T / 0072T are not covered
Do not bill or submit claims with CPT codes 0071T or 0072T for treatment of uterine leiomyomata—use of these uterine fibroid–specific codes is considered not covered for Medicare Advantage Plans and not medically necessary for Commercial Products and may be denied.
Not Covered / Not Medically Necessary
Focused ultrasound ablation of uterine leiomyomata billed with CPT 0071T or 0072T is not covered / not medically necessary under this policy. Code 0071T applies when total leiomyomata volume is less than 200 cc and 0072T applies when total leiomyomata volume is greater than or equal to 200 cc; both code uses for uterine fibroid treatment are excluded from coverage.
Background
MRgFUS combines focused ultrasound energy with MRI guidance and real‑time thermometry to produce thermal coagulation within a targeted focal volume while minimizing effects on surrounding tissues. The technique raises focal tissue temperatures (commonly in the range used to induce coagulation necrosis) to ablate the target. The technology has received FDA approval for specific indications—including treatment of uterine fibroids and palliation of pain from bone metastases—but coverage under this policy is limited to the codes and clinical criteria specified; other applications remain investigational or not covered.
Definitions
Prior Authorization
Prior authorization for MRgFUS required for Medicare Advantage
Prior authorization is required for MRgFUS for Medicare Advantage Plans and is recommended for Commercial Products; use the online authorization tool for participating providers when requesting approval.
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