S8037, Magnetic resonance cholangiopancreatography (mrcp)
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documented clinical indication for MRCP (e.g., symptoms such as obstructive jaundice, cholangitis, biliary-type abdominal pain, pancreatitis).
- Pre-test probability and relevant clinical context (e.g., suspected choledocholithiasis, cholestatic liver enzyme pattern, prior imaging findings).
- Results of prior imaging studies (trans-abdominal ultrasound, CT showing bile duct dilation or suspected stones) to justify MRCP as next diagnostic test.
- Documentation of prior unsuccessful or incomplete ERCP or contraindication to ERCP (when MRCP is being used as an alternative or follow-up study).
Key Coverage Criteria
- Medically necessary MRI or CT imaging in hospital outpatient department when: (1) in clinical trial with specific imaging protocol/equipment not available freestanding facility; (2) scheduled within 24 hours of hospital specialist appointment at same hospital-based facility; (3) known allergy to contrast agent; (4) chronic disease under active treatment requiring same protocol/equipment for prior comparisons at same hospital facility; (5) systemic cancer on active treatment with restaging requir [...]
- Adjunctive imaging in suspected autoimmune pancreatitis (AIP) to evaluate main pancreatic duct narrowing, MPD integrity (secretin-MRCP may demonstrate duct-penetrating sign), and parenchymal features (but MRCP cannot fully replace ERCP in AIP diagnostic workup).
- Imaging of biliary tree to help plan directed interventions (endoscopic or transhepatic) in complex biliary disease where MRCP may increase likelihood of success and decrease risk.
- Preoperative evaluation of the common bile duct prior to laparoscopic cholecystectomy in persons with elevations of their transaminases or common bile duct dilatation on abdominal imaging (ultrasound or CT scan).
- Non-invasive imaging to demonstrate biliary calculi and pancreatic ductal disease (general role of MRCP in biliary/pancreatic evaluation).
- Diagnosis of choledocholithiasis/common bile duct (CBD) stones in patients suspected of having CBD stones (used as a first-line or noninvasive diagnostic test in appropriate clinical settings).
13 Active Policies
UHC-POL-mri-ct-scan-site-of-service, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service
AETNA-CPB-0384, Magnetic Resonance Cholangiopancreatography
CARELON-imaging-of-the-abdomen-and-pelvis-2025-03-23, Imaging of the Abdomen and Pelvis
CARELON-oncologic-imaging-2025-11-15, Oncologic Imaging
UMR-POL-UMR-mri-ct-scan-site-of-service
Related Codes
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