CurrentUnitedHealthcarePolicy CSRAD006OH.E

UN-CSRAD006OH.E - Adult Head Imaging Guidelines -open_in_new

UnitedHealthcare clinical guideline (Ohio only) defining appropriate use, documentation requirements, modality- and condition-specific head imaging guidance for adults; emphasizes minimizing overutilization and appropriate contrast use.

Policy Summary

PayerUnitedHealthcare

PolicyUN-CSRAD006OH.E - Adult Head Imaging Guidelines -open_in_new

Policy CodePolicy CSRAD006OH.E

Change TypeAnnual and interim evidence-based updates (no material clinical change indicated)

Effective DateFeb 3, 2026

Next Review DateN/A

Key ActionSubmit detailed history, physical exam, appropriate labs, and prior imaging to establish medical necessity as specified in condition-specific sections.

SourceLink

POLICY UPDATE CHANGES

Policy History lists annual and interim evidence-based updates with entries on 02/01/2024, 07/01/2024, 05/01/2025, and 11/06/2025.

V1.0.2026Guideline Version

OhioGeographic Scope

MultipleCovered Topics

Quant MRI/3D renderingNot Medically Necessary Items

PET/MRI

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Conditional Procedures

Coverage Summary & Scope

UnitedHealthcare's proprietary, evidence-based Adult Head Imaging Guidelines (Ohio only) define appropriate use of advanced head imaging (CT, MRI, PET, and ultrasound) for adults and support clinician judgement to override guidelines when clinically warranted. The guideline emphasizes minimizing overutilization and optimizing contrast use and safety (including GFR and pregnancy considerations), references major society standards (ACR and others), and requires a pertinent clinical evaluation prior to advanced imaging except in specified exceptions. Effective date: February 3, 2026; last review: January 1, 2026.

Policy Metadata

Policy titleAdult Head Imaging Guidelines (Ohio)

policy_numberCSRAD006OH.E

payerUnitedHealthcare

jurisdictionOhio

versionV1.0.2026

effective date2026-02-03

last review2026-01-01

coverage_stancemixed

Medical-Necessity Criteria (condition-specific groups)

General Clinical Documentation and Appropriate Use

General Clinical Documentation and Appropriate Use: Covered when ALL of the following are met:

ALL of the following

A detailed clinical evaluation (history and physical exam) by the treating clinician or consultant is documented and directly addresses the indication for the requested head imaging study.
Pertinent prior imaging studies (when available) and relevant laboratory results are provided or explicitly noted as unavailable.
Clinical signs or symptoms, onset and/or change in symptoms, and any relevant neurologic findings are documented to support the specific imaging modality requested (CT, MRI, PET, NM, US).
For requests that are follow-up or surveillance in nature, documentation includes prior imaging date, modality, key prior findings, and the specific management question the current study is intended to answer.

Not Medically Necessary / Experimental

Head Trauma and Not Medically Necessary Advanced Modalities for TBI

Head trauma imaging rules including not medically necessary advanced modalities for TBI.

Head Trauma - Acute and Subacute Imaging: CT Head without contrast (70450) is medically necessary for acute head trauma (0-7 days) when any modified Canadian CT Head Rule/New Orleans criteria present (dangerous mechanism, age >60, LOC/amnesia/disorientation within 24 hrs, anticoagulant use, platelet/clotting disorder, GCS <15 at 2 hours, >30 minutes amnesia before impact, suspected open skull fracture, signs of basilar skull fracture, vomiting, intoxication, visible trauma above clavicles, short term memory deficits, seizure, headache). For subacute (7 days to 3 months) or chronic (>3 months) unexplained deficits, MRI Brain without contrast (70551) or CT Head without contrast (70450) is medically necessary. Repeat/follow-up imaging for known subdural hematomas, ICH, or contusions per provider discretion; MRI may complement CT when CT does not explain findings. For suspected intracranial venous/arterial injury, CTA/CTV (70496) or MRA/MRV (70544/70545/70546) is necessary. Advanced/quantitative studies (SPECT, PET, CT/MR perfusion, DTI, fMRI, MRS) and volumetric MRI (0865T/0866T) are considered not medically necessary for TBI evaluation.

Advanced modalities NMP for TBI

Whole-body and hybrid modality positions are conditional: PET/MRI is generally not supported but may be authorized when PET/CT guideline criteria are met AND PET/CT is unavailable at the treating institution and the provider requests PET/MRI (report as CPT 78813 + CPT 76498). Whole-body MRI (WBMRI) is generally not supported except for select cancer predisposition syndromes and some autoimmune uses; WBMRI has no dedicated CPT and when reported must use CPT 76498 only.

Coding: grouped CPT / HCPCS / other codes

MRI Brain / CT Head / Angiography CodesCPTCovered

70551	MRI brain without contrast
70552	MRI brain with and without contrast
70553	MRI brain with contrast
70450	CT head without contrast
70460	CT head with contrast
70470	CT head without and with contrast
70544	Magnetic resonance angiography, head; without contrast material
70545	Magnetic resonance angiography, head; with contrast material
70546	Magnetic resonance angiography, head; without and with contrast material
71260	CT thorax, with contrast material, chest (included per completeness review)

1–10 of 14

1/2

CT Head / Facial / Temporal Bone - covered indicationsCPTCovered

70486	CT facial bones without contrast
70487	CT facial bones with and without contrast
70488	CT facial bones with contrast
69990	Stereotactic computer assisted procedure, cranial (when applicable)
76536	Ultrasound scanning of head and neck (when applicable)

Nuclear Medicine / PET - neutralCPT

78815	PET brain imaging — general PET code
78816	PET imaging, multiple studies or guided studies
78814	PET attenuation correction or limited studies
78650	Radiopharmaceutical localization of brain (included per completeness review)
78600	Tumor imaging; planar or SPECT (listed per completeness review)
78601	Tumor imaging planar; other (listed per completeness review)
78605	Receptor imaging (listed per completeness review)
78606	Other localized tracer imaging (listed per completeness review)
78610	Functional brain imaging, planar (listed per completeness review)
78660	Quantitative planar imaging (listed per completeness review)

PET - not medically necessary / not coveredCPTNot Covered

78700	Brain PET (not medically necessary for autism per group)
93882	Transcranial Doppler (note: included per completeness review)

Quantitative MRI Analysis - Not Medically NecessaryCPTNot Covered

76376	3D rendering with interpretation (quantitative MRI analysis) - not medically necessary
76377	3D rendering without interpretation - not medically necessary
76380	Computer-aided detection (when used for unproven indications)

Amyloid-PET - not coveredCPTNot Covered

0372T	Amyloid PET imaging (not covered)
0373T	Amyloid PET imaging, additional agent (not covered)

3D rendering / Advanced Post-Processing - conditionalCPT

76376	3D rendering with interpretation - conditional
76377	3D rendering without interpretation - conditional

Other Included Codes (mixed) - completeness additionsmixedCovered

76700

Ultrasound, abdominal, real time with image documentation; limited (included per completeness review)

Provider Actions & Operational Rules

Documentation Required

Submit pertinent clinical documentation

Providers must submit a detailed history, physical (including a focused neurologic exam), and any prior imaging to establish medical necessity before advanced head imaging. Include documentation of pertinent dates, symptom onset/changes, and that clinical evaluation occurred (telehealth acceptable when applicable).

Detailed history
Focused neurologic exam
Relevant laboratory studies
Prior imaging (reports/images)

Prior Authorization

Prior authorization may be required for select codes

Prior authorization may be required for select advanced imaging or rendering services. Examples explicitly flagged include 3D rendering CPT 76376 and 76377 and special PET/MRI substitution requests; PET/MRI is allowed only when PET/CT criteria are met, PET/CT is unavailable, and the provider requests PET/MRI.

Background, Evidence & Definitions

Background: these UnitedHealthcare evidence-based guidelines synthesize major society standards (ACR practice parameters and appropriateness criteria and other referenced literature) to guide modality-specific advanced imaging decisions for adult head conditions. The guidance prioritizes MRI over CT for most indications (with CT reserved when MRI is contraindicated or for bony/urgent indications), addresses appropriate use of PET, and stresses reducing unnecessary testing and radiation exposure. The guidelines also highlight contrast safety (GFR thresholds, gadolinium precautions in pregnancy, and NSF risk) and outline required clinical documentation and specialist consultation where relevant.

Evidence	Key value
CTA/MRA sensitivity for aneurysm	CTA >90% sensitivity and specificity; MRA sensitivity ~95% and specificity ~89%
MRI DWI sensitivity for acute infarct	MRI DWI sensitivity 94%, specificity 97%
FDG-PET vs MRI for autoimmune encephalitis	FDG-PET more sensitive (87% vs 56%) than MRI for autoimmune encephalitis
CT sensitivity for SAH within 6 hours	CT negative predictive value 99.9%-100%; sensitivity >90% within first 24 hours (especially within 6 hours)
CTA sensitivity for large vessel occlusion	CTA sensitivity 93%, specificity 100% for large vessel occlusion
CTA for AVM detection vs MRI	CTA sensitivity ~90% overall; 100% for AVMs >3 cm; MRI sensitivity overall 89% (100% for >3 cm)
Cerebral catheter angiography performance	Catheter angiography sensitivity/specificity >98%; can find aneurysms missed by CTA in subset (identifies aneurysm in up to 25% of previously negative studies)
MRI perfusion role	MRI perfusion supported for tumor characterization, grading, surgical planning, and stroke ischemic penumbra assessment; obtained with MRI Brain codes (no extra CPT)
CT Perfusion indications	CT perfusion (CPT 0042T) medically necessary for acute stroke <24h to identify thrombolysis/thrombectomy candidates and other select vascular/tumor uses
MRA abnormality rate in vasculitis	MRA head abnormal in ~81% with angiographic vasculitis; MRI brain abnormal in >95% of CNS vasculitis cases

Definitions / key terms (brief): Red Flag = clinical features mandating imaging or alternate pathways (sudden focal deficits, fever/possible meningitis, trauma, known malignancy, coagulopathy, pregnancy/postpartum, suspected raised ICP, seizure, etc.); ARIA = amyloid-related imaging abnormalities requiring MRI monitoring during anti-amyloid therapy; Epilepsy Protocol = specialized MRI protocol (3T/7T, thin angled hippocampal/temporal sequences) to detect epileptogenic lesions; WBMRI reporting = whole-body MRI currently has no dedicated CPT/HCPCS and must be reported with CPT 76498 when allowed; Concurrent supervision = active physician participation/monitoring required for CPT 76376/76377 3D post-processing; Unit of service (guidance codes) = one unit = one encounter/date of service (only one unit reported regardless of number of lesions for guidance codes); IAC = internal auditory canals (IAC-limited MRI codes 70540/70542/70543 may be used but not in addition to routine MRI Brain when IAC views are included).

Key Thresholds and Surveillance Intervals

Thresholds and Surveillance Intervals

GFR contrast thresholdGFR < 30 mL/min (gadolinium/iodinated contrast risk parity)

RCVS repeat imaging intervalRepeat MRI/MRA/CTA in 2-4 weeks if suspicion high

Hydrocephalus/VP shunt follow-upPost-op imaging 6-12 months then annually if stable

Familial aneurysm screening intervalEvery 5 years beginning at age 20 for high-risk family history

Giant aneurysm sizeGiant aneurysm defined as > 2.5 cm

Aura duration warranting imagingAura > 60 minutes

Trauma age threshold for CT Head

Revision History

02/01/2024change

Summaries indicate evidence-based updates; no specific clinical policy changes were detailed in this part.

07/01/2024change

Summaries indicate evidence-based updates; no specific clinical policy changes were detailed in this part.

05/01/2025change

Summaries indicate evidence-based updates; no specific clinical policy changes were detailed in this part.

Policy Summary

PayerUnitedHealthcare

PolicyUN-CSRAD006OH.E - Adult Head Imaging Guidelines -open_in_new

Policy CodePolicy CSRAD006OH.E

Change TypeAnnual and interim evidence-based updates (no material clinical change indicated)

Effective DateFeb 3, 2026

Next Review DateN/A

Key ActionSubmit detailed history, physical exam, appropriate labs, and prior imaging to establish medical necessity as specified in condition-specific sections.

SourceLink

On This Page

If the request is for imaging after a recent negative or non-diagnostic study of a different modality, rationale is provided for modality substitution (e.g., CT after non-contrast MRI is insufficient for acute hemorrhage evaluation) or for repeat imaging within a timeframe shorter than guideline-specified surveillance intervals.

When contrast-enhanced imaging is requested, there is documentation of the specific clinical question requiring contrast (e.g., neoplasm characterization, suspected abscess, vascular lesion) and review of prior contrast exposure, renal function, and allergy history as applicable.

For individuals ≤18 years, pediatric imaging guidelines apply; for individuals >18 years the adult head imaging guideline applies unless a specific section directs otherwise.

CT vs MRI substitution rules

CT vs MRI substitution rules: preserve decision logic for modality selection and acceptable substitutions.

ALL of the following

Modality selection should be based on the specific clinical question, relative strengths and limitations of CT and MRI, and timeliness of required information.
Acceptable substitutions when specific clinical questions or constraints exist:
- Non-contrast CT head may be substituted for MRI brain when rapid detection of acute hemorrhage, fracture, or acute hydrocephalus is the primary question and MRI is not immediately available.
- MRI brain (with or without contrast as clinically indicated) is preferred over CT for evaluation of most non-acute neurologic syndromes (seizure, progressive focal deficits, demyelinating disease, suspected neoplasm, pituitary lesions, posterior fossa and skull base pathology) due to superior soft-tissue contrast and multiplanar capability.
- CT angiography (CTA) may substitute for MR angiography (MRA) when rapid vascular imaging is required (e.g., acute stroke workflow, suspected dissection) or when MRI is contraindicated; conversely, MRA without contrast may substitute for CTA when iodinated contrast contraindications exist and the diagnostic question can be answered without CTA’s higher spatial resolution.
- When an initial CT is nondiagnostic for a suspected mass, infection, inflammatory, or demyelinating process, MRI with targeted sequences is medically necessary to answer the clinical question unless contraindicated.
If a requested substitution moves from a non-contrast to a contrast-enhanced study (or vice versa), indications for contrast use and contraindications must be documented per contrast considerations section.

Contrast considerations and contraindications

Contrast considerations and contraindications: required documentation and absolute/relative contraindications.

ALL of the following

When contrast (iodinated for CT or gadolinium-based for MRI) is requested, documentation must include the clinical reason for contrast and the patient’s renal function (eGFR within an appropriate recent interval) unless emergent circumstances preclude testing.
Absolute contraindications (any of the following) make contrast use not recommended:
- Known severe anaphylactic reaction to the specific contrast agent without documented desensitization or alternative agent plan.
- For iodinated contrast: documented severe contrast-induced hypersensitivity where no alternative (e.g., MRI or non-contrast study) can answer the clinical question.
Relative contraindications (consider risk-benefit and mitigation):
- eGFR below threshold for contrast administration per institutional policy (often <30 mL/min/1.73m2) — consider risk mitigation, dialysis timing, or alternative imaging modality.
- History of prior moderate allergic-type reaction to contrast — document premedication plan if proceeding.
- Pregnancy — use contrast only if essential for immediate management; prefer non-contrast imaging or MRI without contrast when possible.
Gadolinium-based contrast use should follow local formulary and safety guidance; documentation should reflect whether macrocyclic agents or lower-risk formulations are being used for at-risk patients (e.g., severe renal impairment) and include justification when repeated gadolinium exposures are anticipated.
If unexpected need for contrast arises during a non-contrast exam, proceeding with contrast is medically appropriate when necessary to resolve an unexpected potentially clinically significant finding and when documentation is available per institutional policies.

Appropriate use of PET

Appropriate use of PET for head imaging: clinical situations where PET or PET-CT/MRI is supported.

ALL of the following

PET and PET-CT/PET-MRI are generally reserved for specific indications in head imaging where metabolic information will change management; routine use for general neurological symptoms is not supported.
Medically necessary PET indications include any of the following:
- Evaluation for suspected or known brain tumor recurrence versus treatment-related changes (radiation necrosis) when MRI is equivocal and PET (e.g., FDG, amino-acid tracers) will alter management.
- Pre-surgical localization or mapping for refractory epilepsy when PET metabolic imaging complements MRI and EEG/invasive monitoring and will influence surgical planning.
- Selected neurodegenerative disease evaluation using FDA-cleared amyloid PET agents when clinical diagnostic criteria are met and results will directly impact patient management per established amyloid PET appropriateness criteria.
PET for general cognitive complaints, routine headache evaluation, or nonspecific dizziness without syndrome-specific pretest probability is not routinely supported unless a guideline-specified indication is met.

3D Rendering (CPT 76376 / 76377) Clinical Scenarios and Billing

3D Rendering (CPT 76376 / 76377) Clinical Scenarios and Billing: when 3D rendering/add-on CPTs are appropriate.

ALL of the following

CPT 76376 (3D rendering with interpretation) and CPT 76377 (3D printing with interpretation) are clinically supported only when the 3D rendering or printing materially affects clinical management, surgical planning, or device/prosthesis design beyond the routine interpretation of cross-sectional imaging.
Examples of medically necessary use-cases:
- Preoperative planning for complex cerebrovascular lesions (e.g., large AVM nidus, complex aneurysm geometry) where 3D models change approach or operative strategy.
- Stereotactic neurosurgical planning where 3D reconstructions are required for navigation/trajectory planning not achievable with routine DICOM datasets alone.
- Patient-specific prosthesis or implant design that requires validated 3D printed models.
Routine post-processing for visualization that does not change clinical management is not separately billable as 76376/76377. Documentation must describe how the 3D rendering changed surgical or clinical decisions and reference the primary imaging study date and accession.

CT/MR/US Guidance Procedure Codes (guidance principles)

CT/MR/US Guidance Procedure Codes (guidance principles) and related coding rules.

ALL of the following

Guidance procedure codes (e.g., 77012/77021 for needle placement, 77013/77022 for ablation guidance) should be reported when image guidance is performed and documented as required by CPT; the guidance must be integral to the procedure and documented in the procedural note.
For CT or MR guidance services, differentiate between diagnostic interpretation codes and procedural guidance codes; guidance codes are reported when a separate invasive image-guided procedure (biopsy, aspiration, injection, ablation) is performed, not for diagnostic imaging alone.
When guidance is provided for needle placement, report the appropriate CT/MR guidance code (77012/77021) with the biopsy/CPT for the intervention; when guidance is continuous or monitoring for ablation, use the ablation guidance codes (77013/77022) alongside the ablation CPT code.
Modifiers and laterality rules should follow payer and CPT guidance; do not report guidance codes separately when guidance is included in the primary procedure code per CPT instructions.

Unlisted CT/MR/Nuclear Codes and Interpretation of Outside Studies

Unlisted CT/MR/Nuclear Codes (CPT 76497 / 76498 / 78999) and interpretation of outside studies (CPT 76140).

ALL of the following

Unlisted procedure codes (e.g., 76497, 76498, 78999) may be used when no specific CPT code exists; detailed documentation of the procedure, duration, technical work, and clinical necessity must accompany claims to allow appropriate adjudication.
CPT 76140 (interpretation of an outside diagnostic study) is reported when a qualified physician interprets studies performed at another facility and the original images are not otherwise available; documentation must indicate receipt of outside images and the clinical reason for re-interpretation.
HCPCS and unlisted code use should be accompanied by narrative documentation and, when requested, copies of images or key representative images for review.

HCPCS Code Handling; Whole-Body CT/MRI; PET-MRI

HCPCS Code Handling, Whole-Body CT/MRI, and PET-MRI considerations.

ALL of the following

HCPCS and modality-specific codes should be used per CPT/HCPCS manuals and payer guidance; ensure appropriate grouping of codes and avoid duplicate billing for overlapping technical components.
Whole-body CT and whole-body MRI studies are supported only for specific oncologic, systemic disease, or staging indications documented to require whole-body evaluation; routine use as a screening modality is not supported.
PET-MRI is an advanced hybrid modality and is appropriate only when combined metabolic and high-resolution anatomic information is required and will change management; documentation must justify why PET-CT or MRI alone is insufficient.

General Head Imaging - Pre-evaluation and Modality Selection

General Head Imaging - Pre-evaluation and Modality Selection: principles for choosing imaging based on anatomy, timeliness, and pregnancy considerations.

ALL of the following

Select the imaging modality that best answers the clinical question while minimizing patient risk (radiation exposure, contrast risks, delays).
For suspected acute intracranial hemorrhage, skull fracture, or acute hydrocephalus, non-contrast head CT is the preferred initial study due to speed and sensitivity for blood and bone injury.
For most non-acute or subacute conditions (neoplasm characterization, demyelinating disease, seizure workup, skull base/orbit/optic pathways), MRI brain with appropriate sequences is the preferred modality.
In pregnant or postpartum individuals, avoid ionizing radiation when possible; prefer MRI without gadolinium for most indications. Use CT only when necessary for immediate management (e.g., suspected life-threatening hemorrhage) and document risk-benefit discussion.

Affected codes: 76376, 76377, 78813+76498 (PET/MRI combination)
PET/MRI allowed only if PET/CT criteria met AND PET/CT unavailable AND provider requests substitution
Provider requests or institutional process may trigger prior auth even if base study usually does not require it

Billing Rule

Guidance codes include necessary imaging; single unit per encounter

Guidance and billing rules: do not unbundle PET/CT into separate PET and diagnostic CT CPT codes; guidance procedure codes include all imaging necessary so do not bill a separate diagnostic code with them; only one unit of guidance codes (CT/MR/US/fluoro guidance) may be reported per encounter/date of service; do not report both CPT 70486 and 77011 for the same stereotactic localization session; limited IAC MRI codes should not be billed along with MRI Brain when IAC views are part of the brain study; CPT 76376/76377 (3D rendering) have restrictions and cannot be reported with 77011/70486 in the same session.

Do not unbundle PET/CT (do not bill PET + diagnostic CT separately)
Do not bill diagnostic CT with guidance codes (e.g., 19085/19086/75989/76942/77011/77012/77013/77021/77022)
Single unit per encounter for guidance codes: 77012/77013/77021/77022, 76942, 77002-77003
Do not report CPT 70486 and CPT 77011 for the same stereotactic localization session
Do not report CPT 76376/76377 with CPT 77011 or CPT 70486 (3D dataset inherent)
IAC limited MRI codes (70540/70542/70543) should not be used with MRI Brain codes (70551/70552/70553) if IAC views were performed as part of brain study

Denial Risk

Denial risks & duplicate imaging

Risk of claim denials increases when imaging is duplicative, lacks clinical documentation, or is for advanced modalities without criteria support. Examples: duplicate or unnecessary imaging may be denied; advanced modalities (SPECT, PET, CT/MR perfusion, DTI, fMRI, MRS) are not medically necessary for TBI evaluation; amyloid-PET is limited to MCI or mild AD for therapy eligibility (use per amyloid therapy guidance); advanced imaging for primary headache without red flags is not medically necessary.

Duplicate/unnecessary imaging risk — review prior imaging before ordering
Advanced modalities not medically necessary for TBI: SPECT, PET, perfusion, DTI, fMRI, MRS, quantitative MRI (0865T/0866T)
Amyloid PET (78811/78814) limited to MCI/mild AD per treatment/eligibility criteria
Advanced imaging for primary headache without red flags or focal neurologic deficits is not medically necessary

Documentation Required

Specialist-directed imaging and surgical planning

Specialist-directed imaging is required for many pre-operative, postoperative, and complex vascular/head/neck scenarios. When imaging is requested for neurosurgical planning, vascular interventions, or complex skull-base/orbital procedures, documentation that a neurosurgeon, neurologist, ENT, or radiologist requested or consulted is needed. Examples include epilepsy presurgical workup (FDG-PET, ictal SPECT, fMRI, MEG co-registration), aneurysm follow-up and planning (CTA/MRA/3D rendering), neuronavigation/DBS planning (use CPT 76497/76498 as unlisted when no anatomic code exists), and ENT/vascular planning for embolization.

Epilepsy presurgical: MRI (epilepsy protocol), FDG-PET (78608), ictal SPECT (78803), fMRI (70554/70555), MEG co-registration — requested by neurosurgeon/neurologist
Aneurysm follow-up/operative planning: CTA head (70496) or MRA head (70544/70545/70546) ± MRI brain; 3D rendering (76376/76377) with angiography when requested by treating team
Neuronavigation/DBS/stealth imaging: use unlisted CT/MR codes (76497/76498) for image acquisition/registration when no anatomic code exists; diagnostic code only required if radiologist interpretation is necessary
ENT/surgical planning (epistaxis embolization, complex sinus surgery): CT maxillofacial (70486/70487) and CTA/CTA neck (70496/70498) when requested by operative clinician

Documentation Required

Coding & interpretation operational notes

Operational coding notes for image interpretation and unlisted procedures: interpret outside studies using CPT 76140 rather than diagnostic imaging codes; use unlisted procedure codes when no anatomic CPT exists (CPT 76497 for CT, 76498 for MRI, 78999 for nuclear medicine); whole-body MRI (WBMRI) should be reported using CPT 76498 only; WBMRI has no specific CPT/HCPCS codes; WBMRI and neuronavigation acquisitions often require unlisted codes; for WBMRI and neuronavigation, include justification and note concurrent use rules.

Interpretation of outside exams: use CPT 76140
Use CPT 76497 (unlisted CT), CPT 76498 (unlisted MR), or CPT 78999 (unlisted nuclear) when no anatomic code exists
WBMRI reportable only with CPT 76498; do not report multiple anatomic MRI codes to represent WBMRI
Use CPT 76497/76498 for neuronavigation image acquisition/registration; report diagnostic codes only if radiologist supervision/interpretation performed

Age > 60 years (CT Head indicated in acute trauma per rules)

GCS threshold for trauma CTGCS <15 at 2 hours post-injury

Repeat imaging for unclear MS diagnosisRepeat MRI Brain 3-6 months after initial MRI

MS/Tysabri surveillance (brain)MRI Brain every 3-6 months for prolonged Tysabri (JC+ ≥18 months)

MS/Tysabri surveillance (spine)MRI cervical/thoracic annually on high-risk DMT

Transverse myelitis surveillanceAnnual MRI (brain/cervical/thoracic) for 5 years

11/06/2025change

Summaries indicate evidence-based updates; no specific clinical policy changes were detailed in this part.