General imaging coverage criteria — Covered when imaging is supported by adequate clinical evaluation and expected to impact management
Covered when imaging is supported by adequate clinical evaluation and expected to impact management. Advanced imaging and specialized techniques are addressed below with their specific coverage stances and documentation requirements.
Adequate clinical documentation must be submitted to establish medical necessity, including: recent detailed history, physical examination since onset/change in symptoms, relevant laboratory and prior imaging studies, and documentation that results will impact management.
Plain radiographs are required when specified by condition-specific sections and must have been performed after the current episode of symptoms began or changed unless otherwise stated (e.g., high-risk trauma, ankylosing spondylitis/DISH exceptions).
An in-person clinical evaluation for the current episode is required prior to consideration of advanced imaging unless a red flag indication exists. Clinical re-evaluation is required after a trial of provider-directed treatment (see specific criteria elsewhere).
Advanced imaging is generally not indicated for resolved or improving spinal pain or longstanding stable spinal pain without neurological features or clinically significant change in exam.
Repeat advanced imaging should be carefully considered. Serial surveillance imaging for healing or recovery is not routinely supported unless there is evidence of progression, recurrence, or the imaging will change management (e.g., concern for delayed union, pseudoarthrosis).
Imaging guidance: Image-guided procedures are covered when medically necessary for diagnosis or therapy and when documentation supports that guidance will materially change procedural safety or outcome. Use appropriate, billed guidance codes consistent with the procedure performed. Fluoroscopy, CT guidance, ultrasound guidance, or fluoroscopic/CT myelography guidance may be allowed based on the clinical context and procedural requirements.
3D rendering/advanced post-processing (including 3D reconstructions and surgical planning renderings) may be considered when ALL of the following are met: the rendering is essential to answer a specific clinical question or to plan an operative procedure; the surgical or interventional plan explicitly documents reliance on the 3D render for operative approach or hardware placement; and conventional multiplanar images are insufficient. Routine or cosmetic 3D renderings, or those performed solely for illustrative or patient education purposes, are not covered.
Quantitative MRI techniques (including but not limited to quantitative mapping, advanced diffusion metrics, morphometric quantitation, and other quantitative post-processing beyond standard diagnostic interpretation) are considered investigational/experimental for spine indications and are not covered unless supported by specific condition-based guidelines or an approved clinical trial.
Whole-body imaging (e.g., whole-body MRI) is generally not supported except for select cancer predisposition syndromes or specific autoimmune conditions described in condition-specific guidelines. Whole-body MRI should be reported using CPT 76498 when appropriate; use of multiple-body-part MRI codes to represent a true whole-body protocol is not appropriate.
Unlisted procedure coding: When a study lacks a specific CPT/HCPCS code and is medically necessary (e.g., certain PET/MRI combinations, novel protocols), submit the most appropriate unlisted code with thorough clinical documentation, reason unlisted code is used, and supporting reports/images. CPT unlisted codes will be reviewed case-by-case; lack of standardization or investigational status may result in non-coverage.
Lower extremity radiculopathy (with or without low back pain): Advanced imaging of the lumbar spine is covered when ALL of the following are met: in-person clinical evaluation for the current episode; failure of a recent (within 12 weeks) six-week trial of provider-directed treatment with clinical re-evaluation (unless a red flag is present); results of plain X-rays of the lumbar spine performed after the current episode started or changed when required by the condition-specific section; and documentation of radicular distribution (dermatomal pattern), sensory/motor deficits, and reflex findings. For severe radicular pain (minimum 9/10 VAS) with significant functional loss unresponsive to 7 days of provider-directed treatment and a planned intervention (e.g., TFESI, urgent surgery, or urgent spine specialist referral), imaging may be expedited per Red Flag/Severe Radiculopathy criteria.
Cancer-related spinal pain: When there is clinical suspicion for spinal malignancy, advanced imaging is indicated when one or more of the following are present: night pain, unexplained weight loss, pain unrelieved by positional change, age >70, or severe/worsening pain despite reasonable trial of therapy. Imaging options include MRI of the relevant spinal level (without or without and with contrast), CT of the relevant level (with or without contrast), or CT myelography when MRI is contraindicated. For individuals with known malignancy and suspected acute spinal cord compression or metastatic disease, follow the Oncology Imaging Guidelines for specific imaging pathways.
Routine post-fusion imaging / prolonged intractable pain: Routine advanced imaging following spinal fusion is not indicated in the absence of new or worsening clinical symptoms. Advanced imaging >6 months post-operative may be covered when ALL of the following are met: recent plain radiographs of the affected region with results available; no significant improvement after a recent (within 12 weeks) six-week trial of provider-directed treatment with clinical re-evaluation; or presence of red flag indications. Nuclear medicine studies (e.g., bone scan, SPECT) may be considered when MRI/CT are nondiagnostic or when metal artifact limits MRI evaluation.
Imaging for Spinal Cord Stimulator (SCS) Placement/Removal: MRI Thoracic Spine without contrast (CPT 72146) is generally the study of choice prior to SCS placement. Acceptable alternatives when MRI is contraindicated include CT Thoracic Spine without contrast (CPT 72128) or CT Myelography Thoracic Spine (CPT 72129). Imaging of the lumbar spine is not indicated for placement or removal of spinal cord stimulators.
Following Vertebral Augmentation Procedures (e.g., kyphoplasty/vertebroplasty): CT without contrast of the affected spinal region within 24 hours post-procedure is indicated to evaluate neurologic sequelae from cement extravasation or other acute complications. Routine MRI or other advanced imaging solely for surveillance after vertebral augmentation is not supported unless clinically justified.
Advanced imaging and nuclear medicine coverage criteria: Advanced imaging (MRI, CT, CT myelography) and nuclear medicine studies (bone scan, SPECT, WBS) are covered when condition-specific criteria and documentation requirements are met. Nuclear medicine studies may be appropriate for radiographically occult fractures, evaluation of suspected infection when MRI/CT are nondiagnostic, evaluation of suspected loosening or pseudoarthrosis when MRI is limited by hardware artifact, and for staging/restaging of certain oncologic conditions per Oncology guidelines. PET/CT is covered per condition-specific criteria; PET/MRI and whole-body MRI are generally not supported except in select circumstances described above.
Operational notes: Prior authorization may be required for many advanced imaging procedures—verify payer-specific requirements. When unlisted, investigational, or combined modality studies are requested, include detailed clinical rationale, prior imaging, and how the result will change management. Lack of adequate documentation may result in denial.
Medical necessity criteria for advanced spine and whole-body imaging — Covered when criteria and documentation requirements are met
Medical necessity criteria for advanced spine and whole-body imaging — Covered when criteria and documentation requirements are met.
Whole-body MRI (WBMRI) is generally not supported due to lack of standardization and insufficient evidence of improved outcomes, except for select cancer predisposition syndromes and certain autoimmune conditions (see condition-specific sections). When supported, WBMRI should be reported using CPT 76498; other reporting methods are inappropriate.
PET-MRI is generally not supported for most oncologic and neurologic conditions due to lack of standardization. PET-MRI may be appropriate when the individual meets condition-specific PET-MRI or PET-CT criteria AND PET-CT is unavailable at the treating institution. When approved, PET-MRI should be reported using PET Whole-Body (CPT 78813) plus MRI unlisted code with documentation; diagnostic MRI codes may be indicated concurrently when clinically appropriate.
PET/CT for spine: Spine PET/CT is considered not medically necessary for routine spine disorders other than neoplastic disease. Use per Oncology Imaging Guidelines.
Cone-beam CT for cervical spine imaging is considered not medically necessary.
Standard coverage with prerequisites — Advanced spinal imaging covered when ALL listed preconditions are met (unless Red Flag present)
Standard coverage with prerequisites — Advanced spinal imaging covered when ALL listed preconditions are met (unless a Red Flag is present).
An in-person clinical evaluation for the current episode is required before advanced imaging is considered. Clinical re-evaluation after a trial of provider-directed treatment is required prior to imaging unless a red flag is present.
Failure of a recent (within 12 weeks) six-week trial of provider-directed treatment is required unless a Red Flag applies. Provider-directed treatment may include education, activity modification, NSAIDs, analgesics, oral or injectable corticosteroids, home exercise/stretching program, physical/occupational therapy, spinal manipulation, or interventional procedures.
Results of plain X-rays must be available to the requesting provider when specified by the condition-specific guideline (performed after the current episode of symptoms started or changed), except in high-risk mechanisms or specified exceptions (e.g., ankylosing spondylitis/DISH).
Documentation must include neurological examination details (dermatomal distribution of altered sensation, motor testing with myotomal distribution, reflexes, and nerve root tension signs).
Red flag indications (immediate imaging) — Advanced imaging indicated without waiting for conservative therapy when ANY red flag is present
Red flag indications (immediate imaging) — Advanced imaging indicated without waiting for conservative therapy when ANY red flag is present.
Red Flag indications include: Motor weakness (new onset grade ≤3/5, foot drop, bilateral lower extremity weakness, progressive objective motor/sensory/reflex deficits), Aortic aneurysm or dissection, Cancer (suspicion for spinal malignancy), Cauda Equina Syndrome, Fracture, Infection (spinal osteomyelitis/epidural abscess), and Severe Radicular Pain.
For motor weakness: advanced imaging = MRI of the relevant spinal level without contrast or without and with contrast.
For cauda equina syndrome: MRI Lumbar Spine without contrast (CPT 72148) or without and with contrast (CPT 72158).
For infection suspicion: MRI with and without contrast is preferred; alternatives include CT with IV contrast, 3-phase bone scan of the complete spine, or gallium whole-body scan when indicated. Presence of new neurologic deficit or cauda equina mandates MRI with and without contrast.
Repeat imaging — Repeat imaging coverage considerations
Repeat imaging — Repeat imaging coverage considerations.
Repeat advanced imaging is not routinely supported unless there is clinical evidence of progression, recurrence, new or worsening neurological signs/symptoms, concern for delayed union/non-union, pseudoarthrosis, or when repeat imaging will change management.
Requests for simultaneous similar studies (e.g., spinal MRI and CT) require documentation that both studies are necessary for preoperative planning or evaluation of complex failed fusion cases where both soft tissue and bony anatomy determination is required.
Serial advanced imaging for surveillance of healing or recovery is not supported for the majority of spinal disorders.
MRI indications — MRI of the spine is indicated for evaluation when the listed clinical situations are present
MRI indications — MRI of the spine is indicated for evaluation when the listed clinical situations are present.
MRI Spine indications include evaluation of disc disease, spinal cord and nerve root disorders, congenital anomalies, suspicion or surveillance of neoplastic disease, suspected or known spinal infection, multiple sclerosis or other myelitis, syringomyelia, cauda equina syndrome, and preoperative evaluation to define variant spinal anatomy that could affect surgical outcome.
Magnetic Resonance Spectroscopy (MRS) for all spine uses is considered not medically necessary.
Positional/weight-bearing MRI is considered not medically necessary due to inadequate evidence.
MRI is preferred modality for myelopathy evaluation and is generally indicated in initial work-up; CT/myelography may be considered when MRI is contraindicated or for surgical planning.
CT indications — CT of the spine allowed when MRI contraindicated or for specific bony/pathology indications
CT indications — CT of the spine allowed when MRI contraindicated or for specific bony/pathology indications.
CT may be approved in place of MRI when MRI contraindications are documented (e.g., implanted ferromagnetic materials, non-MRI compatible implanted devices).
CT without contrast (or with contrast as requested) is appropriate for spinal trauma/fractures, evaluation of osseous anatomy for preoperative planning, congenital or acquired spinal deformity, assessment of spinal fusions when pseudoarthrosis is suspected, spondylolysis when X-rays are negative and MRI equivocal, and to evaluate calcified lesions (e.g., osteophytes, OPLL).
CT myelography may be used with CT when indicated (see CT myelography section).
CT myelography indications — CT myelography permitted for specific indications when MRI is nondiagnostic or contraindicated
CT myelography indications — CT myelography permitted for specific indications when MRI is nondiagnostic or contraindicated.
CT myelography is generally unnecessary as an initial study when diagnostic quality MRI is available.
Indications include: clarification of equivocal/indeterminate/non-diagnostic MRI findings; preoperative planning when MRI is insufficient; evaluation after prior spinal surgery when MRI with and without contrast is contraindicated or nondiagnostic.
Only post-myelogram CT procedure codes (e.g., CPT 72126, 72129, 72132) are allowed for authorization; myelogram catheterization codes themselves (e.g., CPT 72265, 62284) are not authorized separately under these guidelines.
Post-discography CT — Post-lumbar discography CT guidance/indication
Post-discography CT — Post-lumbar discography CT guidance/indication.
Post-lumbar discography CT procedure codes are allowed only following an approved discography and when ALL of the following apply: the post-discography CT is verified and the discography was approved; a CT Lumbar Spine without contrast (CPT 72131) is indicated if verified as post-discography CT. Authorization will be issued for the post-discography CT procedure codes when discography has been approved.
Not medically necessary / Controversial procedures — Procedures considered not medically necessary or controversial
Not medically necessary / Controversial procedures — Procedures considered not medically necessary or controversial.
Positional MRI (dynamic/weight-bearing/kinetic MRI) is considered not medically necessary.
Magnetic Resonance Spectroscopy (MRS) for spine uses is considered not medically necessary.
Cone-beam CT for cervical spine imaging is considered not medically necessary.
Spine PET/CT for routine assessment of non-neoplastic spinal disorders is considered not medically necessary.
Prerequisites for advanced spinal imaging (general) — Covered when ALL listed preconditions are met
Prerequisites for advanced spinal imaging (general) — Covered when ALL listed preconditions are met.
An in-person clinical evaluation for the current episode of the condition is required prior to advanced imaging (initial evaluation or re-evaluation).
Clinical re-evaluation after a recent (within 12 weeks) six-week trial of provider-directed treatment is required prior to imaging unless a red flag is present.
When specified, results of plain X-rays performed after the current episode of symptoms started or changed must be available to the requesting provider.
For individuals with ankylosing spondylitis or DISH, whole-spine MRI and CT may be approved and plain X-rays and a 6-week trial of conservative treatment may not be required.
Spinal canal ultrasound indications — Ultrasound (CPT 76800) coverage criteria
Spinal canal ultrasound indications — Ultrasound (CPT 76800) coverage criteria.
Spinal canal ultrasound is generally limited to infants, newborns, and young children due to incomplete vertebral ossification for evaluation of CSF, suspected occult spinal dysraphism, suspected tethered cord when ossification incomplete, evaluation of spinal cord tumors, vascular malformations, or birth-related trauma.
Ultrasound is contraindicated for assessment of adult spine pain, radiculopathy, facet inflammation, nerve root inflammation, disc herniation, and most soft tissue conditions of the adult spine except for superficial masses.
PET/CT for spine — Coverage stance
PET/CT for spine — Coverage stance.
Spine PET/CT is controversial and considered not medically necessary for routine assessment of spinal disorders other than neoplastic disease. Use is guided by Oncology Imaging Guidelines for spinal/vertebral metastases and other cancer-specific indications.
Cone-beam CT — Coverage stance
Cone-beam CT — Coverage stance.
Cone-beam CT for imaging of the cervical spine is considered not medically necessary.
General preconditions for advanced spine imaging — Covered when ALL of the following are met (non-red-flag presentations)
General preconditions for advanced spine imaging — Covered when ALL of the following are met (non-red-flag presentations).
In-person clinical evaluation for the current episode is required.
Failure of a recent (within 12 weeks) six-week trial of provider-directed treatment, unless a red flag exists.
Clinical re-evaluation after treatment period (may be in-person or other meaningful contact) is required.
When indicated by condition-specific sections, results of plain radiographs performed after the current episode must be available.
High-risk and ankylosing spondylitis/DISH exceptions — Exceptions / alternative coverage
High-risk and ankylosing spondylitis/DISH exceptions — Exceptions / alternative coverage.
For individuals with ankylosing spondylitis or DISH, whole-spine MRI and CT can be approved; plain X-rays and a 6-week trial of treatment may not be required.
High-risk mechanisms for suspected cervical/thoracic spine injury may obviate plain radiograph prerequisites and permit immediate CT imaging per trauma protocols.
Coccydynia / Pelvic imaging — Required elements prior to advanced imaging
Coccydynia / Pelvic imaging — Required elements prior to advanced imaging.
Plain X-rays of the sacrum/coccyx must be negative for fracture prior to advanced imaging unless other clinical indications or red flags are present.
MRI Pelvis without contrast (CPT 72195) is the preferred study; CT Pelvis without contrast (CPT 72192) is an alternative when MRI is contraindicated.
Lower extremity radiculopathy with or without low back pain — Required elements prior to advanced imaging
Lower extremity radiculopathy with or without low back pain — Required elements prior to advanced imaging.
All of the following are required prior to advanced imaging for lumbar radiculopathy: in-person clinical evaluation for the current episode; failure of a recent (within 12 weeks) six-week trial of provider-directed treatment unless a red flag is present; clinical re-evaluation after treatment; and results of plain X-rays of the lumbar spine performed after the current episode when required.
Definitions of radiculopathy, radiculitis and radicular pain and documentation of focal neuropathies (e.g., sciatic, femoral, peroneal neuropathies) should follow the Definitions section and Peripheral Nerve Imaging Guidelines where applicable.
Advanced imaging options include MRI Lumbar Spine without contrast (CPT 72148) or without and with contrast (CPT 72158); CT Lumbar Spine without contrast (CPT 72131) or CT myelogram (CPT 72132) when MRI is contraindicated or nondiagnostic.
Permitted advanced imaging modalities — Advanced diagnostic imaging modalities allowed
Permitted advanced imaging modalities — Advanced diagnostic imaging modalities allowed.
Permitted modalities include MRI (with or without contrast as clinically indicated), CT (with or without IV contrast), CT myelography, nuclear medicine studies (bone scan, SPECT, WBS), PET/CT per oncology criteria, and targeted ultrasound in pediatric indications.
Modality selection should be driven by the clinical question, contraindications, and likelihood that imaging results will change management.
Myelopathy - Indications for Advanced Imaging — Advanced imaging indicated for documented or suspected myelopathy
Myelopathy - Indications for Advanced Imaging — Advanced imaging indicated for documented or suspected myelopathy.
Advanced imaging is generally indicated in the initial evaluation of documented or reasonably suspected myelopathy; conservative treatment is not required prior to imaging.
MRI Cervical and Thoracic Spine without contrast or without and with contrast are indicated for evaluation of suspected myelopathy and associated long-tract signs (e.g., unexplained Babinski/Hoffmann, hyperreflexia, bilateral motor weakness).
MRI of cervical, thoracic, and lumbar spine without or without and with contrast is indicated for suspected tethered cord or low-lying conus medullaris.
Myelopathy - CT / CT Myelogram — CT considerations for myelopathy
Myelopathy - CT / CT Myelogram — CT considerations for myelopathy.
CT without contrast or CT with myelography may be considered as an alternative when MRI is contraindicated or in addition to MRI for surgical planning.
CT can demonstrate bony encroachment; CT myelogram may better demonstrate bony neuroforaminal narrowing when MRI is ambiguous.
Spondylolysis - Indications and sequencing — Imaging pathway for spondylolysis
Spondylolysis - Indications and sequencing — Imaging pathway for spondylolysis.
Plain X-rays after the current episode are required unless clinical suspicion is high (where X-ray is not required). Tomographic/SPECT or SPECT/CT bone scan may be used to detect active spondylolysis. Negative SPECT bone scan should prompt MRI lumbar spine without contrast or CT lumbar spine without contrast.
CT lumbar spine without contrast is used to evaluate a lesion seen on SPECT or to evaluate bony anatomy and to monitor healing of pars interarticularis fractures when indicated.
Spondylolisthesis - Indications for advanced imaging
Spondylolisthesis - Indications for advanced imaging.
CT lumbar spine without contrast or MRI lumbar spine without contrast may be considered after plain X-ray for failure of a six-week trial of provider-directed treatment, preoperative evaluation, or presence of red flags.
Lumbar Spinal Stenosis — Indications for advanced imaging (MRI or CT without contrast) when listed findings present
Lumbar Spinal Stenosis — Indications for advanced imaging (MRI or CT without contrast) when listed findings present.
MRI Lumbar Spine without contrast or CT Lumbar Spine without contrast is indicated for suspected lumbar spinal stenosis when red flags are present, after failure of a six-week trial of provider-directed treatment with clinical re-evaluation, or for severe neurogenic claudication severely restricting activity.
CT myelogram may be considered for surgical planning when MRI is contraindicated or surgeon requests additional detail for multi-level stenosis.
CT Myelogram lumbar spine — CT myelogram may be considered when listed criteria apply
CT Myelogram lumbar spine — CT myelogram may be considered when listed criteria apply.
CT myelogram is appropriate to clarify equivocal MRI findings, evaluate prior surgery when MRI is contraindicated or nondiagnostic, and for specific preoperative planning requests from the operating surgeon.
Sacro-iliac Joint Pain / Sacroiliitis — Indications for pelvic imaging (CT or MRI) when ALL listed criteria are met
Sacro-iliac Joint Pain / Sacroiliitis — Indications for pelvic imaging (CT or MRI) when ALL listed criteria are met.
CT Pelvis without contrast or MRI Pelvis without contrast is indicated when initial plain X-rays are equivocal or non-diagnostic AND one of the following: failure of 6 weeks of provider-directed treatment with re-evaluation, fractures of sacrum/SI joint, red flag indications, preoperative planning, or suspicion of neoplastic/inflammatory/infectious disease.
MRI Pelvis without and with contrast is indicated for pediatric juvenile idiopathic arthritis when clinically appropriate; CT pelvis without contrast is an alternative when MRI contraindicated.
Spinal Compression Fractures — Indications for advanced imaging after plain X-ray evaluation
Spinal Compression Fractures — Indications for advanced imaging after plain X-ray evaluation.
MRI without contrast, CT without contrast, whole body bone scan (CPT 78306), SPECT (CPT 78803), or SPECT/CT (CPT 78830) of the affected spinal region is indicated when plain X-rays are non-diagnostic and severe spinal pain persists >1 week in individuals predisposed to insufficiency fractures, for surgical planning for candidates for kyphoplasty/vertebroplasty, or when acuity on plain X-ray is indeterminate.
Advanced imaging assists in distinguishing acute from chronic fractures (e.g., marrow signal on MRI) and is supported when results will affect management (e.g., vertebral augmentation decisions).
Vertebral compression fracture imaging — Covered when ALL of the following are met
Vertebral compression fracture imaging — Covered when ALL of the following are met.
Advanced imaging after plain radiographs when location and clinical presentation are concordant and when one or more of the specific indications above (e.g., nondiagnostic X-ray with persistent severe pain, surgical planning) are present.
Syringomyelia initial and follow-up imaging — Covered when ALL of the following are met
Syringomyelia initial and follow-up imaging — Covered when ALL of the following are met.
MRI Cervical and Thoracic Spine without contrast (and brain MRI when indicated) is required to evaluate syrinx extent; if a syrinx is identified, MRI of the entire spinal axis (cervical, thoracic, lumbar) without contrast or without and with contrast may be indicated to define extent or identify skip lesions.
Follow-up: annual imaging until non-progression established; then advanced imaging every three years for life once non-progression is confirmed. Repeat imaging is indicated with neurologic deterioration or following surgical treatment as clinically indicated.
Spinal deformity imaging and preoperative planning — Covered when ALL of the following are met
Spinal deformity imaging and preoperative planning — Covered when ALL of the following are met.
MRI without contrast or without and with contrast, or CT/myelography if MRI contraindicated, is indicated after plain X-rays (e.g., Cobb films) have been performed and results are available. CT is indicated for complex osseous deformity for preoperative planning.
CTA or MRA is not medically necessary for initial anterior spinal surgery planning unless abnormal vasculature is known or reasonably anticipated. For revision anterior spinal deformity surgery, CTA or MRA may be indicated when requested by the surgeon.
Greater than Six Months Post-Operative — Advanced imaging >6 months post-op covered when ALL listed criteria are met
Greater than Six Months Post-Operative — Advanced imaging >6 months post-op covered when ALL listed criteria are met.
Following plain X-rays post-surgical with results available, MRI without and with contrast, MRI without contrast, or CT without contrast of the affected region is indicated when there is no significant improvement after a recent six-week trial of provider-directed treatment with clinical re-evaluation, or when red flags are present.
Nuclear medicine imaging may be considered when MRI/CT are nondiagnostic in suspected failed fusion.
Revision Anterior Fusion and Preoperative Imaging — Requirements for revision anterior fusion and preoperative planning
Revision Anterior Fusion and Preoperative Imaging — Requirements for revision anterior fusion and preoperative planning.
If requested by the operating surgeon, MRA pelvis (CPT 72198) and/or MRA abdomen (CPT 74185) may be authorized for preoperative planning for revision thoracic or lumbar anterior spinal arthrodesis when abnormal vasculature is suspected or prior imaging suggests vascular considerations.
CT angiography or MR angiography may be indicated but consider risks including radiation exposure, availability, potential out-of-pocket costs, and sensitivity to patient movement.
Imaging for SCS Placement/Removal — Spinal cord stimulator placement imaging requirements
Imaging for SCS Placement/Removal — Spinal cord stimulator placement imaging requirements.
MRI Thoracic Spine without contrast (CPT 72146) is generally the study of choice prior to spinal cord stimulator placement. CT Thoracic Spine without contrast (CPT 72128) or CT Myelography Thoracic Spine (CPT 72129) are acceptable alternatives when MRI is contraindicated.
Imaging of the lumbar spine is not indicated for placement or removal of spinal cord stimulators.
Documentation should indicate how imaging will guide lead placement or identify contraindications to SCS placement.
Following Vertebral Augmentation Procedures — Post-vertebral augmentation imaging
Following Vertebral Augmentation Procedures — Post-vertebral augmentation imaging.
CT without contrast of the affected spinal region within 24 hours post-procedure is indicated to evaluate for neurologic sequelae from cement extravasation or other acute complications.
Routine advanced imaging after vertebral augmentation is not supported unless clinically indicated by new or worsening neurologic symptoms or other complications.
Advanced imaging and nuclear medicine coverage criteria — Covered when criteria below are met for advanced imaging or nuclear medicine studies
Advanced imaging and nuclear medicine coverage criteria — Covered when criteria below are met for advanced imaging or nuclear medicine studies.
Advanced imaging (MRI, CT, CT myelography) and nuclear medicine studies (bone scan, SPECT, SPECT/CT, WBS) are covered when condition-specific clinical criteria and documentation requirements are satisfied, and when results are expected to impact management.
Nuclear medicine is supported for radiographically occult fractures, evaluation of suspected loosening or pseudoarthrosis when MRI limited by hardware artifact, suspected spinal osteomyelitis when MRI/CT are nondiagnostic, and for selected oncologic indications per Oncology Imaging Guidelines.
Spine PET/CT is limited to oncologic indications per Oncology Imaging Guidelines. PET/MRI and whole-body MRI are generally not supported except in select, well-documented clinical circumstances.
When submitting for unlisted or investigational imaging procedures, include detailed clinical rationale, prior imaging results, description of the technique/protocol, and explanation of how findings will change management. Coverage will be determined case-by-case based on available evidence and clinical necessity.