Billing and Coding: Lumbar MRI

Coverage for lumbar MRI requires that the test be medically reasonable and necessary with legible medical records documenting clinical findings, prior treatment, and supporting the ICD-10-CM code(s); an attending/treating physician's signed and dated order is required. Normally only one lumbar MRI is sufficient, with repeat same-area MRIs restricted unless documentation demonstrates the need for comparative results to guide treatment; non-physician-owned clinics billing primarily for diagnostics may need to enroll as IDTFs.

"Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed."

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