Preface to the Imaging Guidelines

This policy covers evidence‑based clinical guidelines for selection and authorization of advanced imaging and related procedures (e.g., NM, US, CT, MRI, PET), radiation oncology, sleep studies, gastrointestinal endoscopy, and cardiac, musculoskeletal and spine interventions for patients presenting with common symptoms and symptom complexes. Coverage requires documented medical necessity and adequate clinical information, is intended for imaging used in direct clinical management (not solely for data collection), may be limited or superseded by Health Plan or CMS policies (including Medicare/Medicare Advantage and CMS CED clinical trials), and requests for atypical presentations or investigational studies require physician review.

"Contraindications to MRI explicitly listed: bullets or shrapnel"

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