Functional Magnetic Resonance Imaging

Aetna covers fMRI as medically necessary to identify eloquent cortex in pre-surgical evaluation of patients with brain tumors (excluding temporal tumors), epilepsy (excluding temporal neocortical epilepsy), or vascular malformations for the listed ICD-10 diagnoses (C71.*, C79.31-49, D33.0-2, D43.0-2, D43.4) when selection criteria are met. fMRI is considered experimental/investigational and not covered for pre-surgical mapping in temporal tumors or temporal neocortical epilepsy and for other indications (e.g., Alzheimer's, anger/aggression, anxiety, anoxic-ischemic brain injury) because effectiveness has not been established.

"fMRI lateralizes language in children with cerebral lesions."

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