Neck Imaging Guidelines

This policy covers advanced neck imaging—including ultrasound of neck soft tissues (CPT 76536), contrast-enhanced CT of the neck (usually CPT 70491), and MRI neck with and without contrast (CPT 70543) when indicated—for evaluation of symptoms and anatomic regions from the skull base and nasopharynx to the clavicles, including thyroid/parathyroid, salivary glands, lymph nodes, suspected masses or adenopathy, neurogenic tumors, and preoperative staging of thyroid carcinoma. Major limitations/requirements: a current clinical evaluation (typically within 60 days), appropriate laboratory studies and initial non-advanced imaging (plain films/ultrasound) are required before advanced imaging; CT without-and-with contrast (CPT 70492) is discouraged due to added radiation, contrast is generally used except for tracheal evaluation or when it may obscure salivary stones, MRI is reserved for cases where CT/US suggest further evaluation, and iodine contrast may transiently affect timing of radioactive iodine studies (clears in ~4–8 weeks).