Billing and Coding: Lumbar MRI

Lumbar MRI is covered only when medically reasonable and necessary (generally one study is sufficient); MRI abnormalities alone do not justify the test without supporting clinical rationale. Coverage requires a legible medical record that supports the billed ICD‑10 code(s), a signed and dated attending/treating physician order, documentation of clinical findings and prior treatment in the MRI report or referring clinician’s record to justify a diagnosis/treatment change, and non‑physician‑owned clinics billing primarily for diagnostics may need to enroll as an IDTF.

"T82."

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