Preface to the Imaging Guidelines

This policy covers diagnostic imaging services — including plain radiography, CT, MRI, and ultrasound (and use of contrast or advanced imaging) — guided by eviCore’s Clinical Decision Support for common symptom complexes, spine/musculoskeletal conditions, malignancy surveillance, and situations where MRI is contraindicated (e.g., pacemakers, ICDs, certain metal implants). Major requirements and limitations include a recent clinical evaluation or documentation within 60 days (x‑rays may be from the current symptom episode for spine/MSK), physician review for atypical presentations, prohibition on ordering advanced imaging before clinical assessment, and adherence to payer/Medicare coverage rules and investigational exclusions.

"Duplicate or questionably indicated examinations (implicit exclusion/limitation — should be avoided)"

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