S0837
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation may be required to support requests for imaging; the documentation must reflect the clinical situation and document the ordering clinician’s intent.
Key Coverage Criteria
- Annual MRI breast screening indicated for individuals who received chest radiation between ages 10 and 30.
- Annual MRI breast screening indicated for individuals with BRCA1 or BRCA2 mutations.
- Annual MRI breast imaging indicated for individuals with extremely dense breast tissue aged 50 or older.
- Annual MRI breast screening indicated for individuals with lifetime breast cancer risk ≥20% as defined by specified models.
- Screening CT colonography indicated for average-risk individuals as an alternative to conventional colonoscopy at 5-year intervals, starting at age 45.
- Annual LDCT indicated for adults 50-80 with a 20+ pack-year history, no signs of cancer, and no limiting comorbidity.
2 Active Policies
CARELON-oncologic-imaging-2025-11-15, Oncologic Imaging
CARELON-oncologic-imaging-2026-04-04, Oncologic Imaging
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.