Musculoskeletal Imaging Guidelines

This policy covers advanced musculoskeletal imaging for non‑spinal MSK conditions—including MRI, CT, SPECT/nuclear medicine, 3D rendering and related modalities—across many indications such as arthritis/joint degeneration, fractures, infection, ligament/tendon and meniscal injuries, osteonecrosis, osteoporosis, post‑operative follow‑up, masses/cysts, limb‑length discrepancy and general MSK pain. Major limitations and requirements include exclusion of spinal conditions (addressed separately), mandatory complete documentation and in‑person clinical evaluation with re‑evaluation after conservative care before advanced imaging is considered, physician review for atypical presentations, and procedural constraints for certain studies (e.g., single‑area vs multi‑area SPECT and requirement for concurrently acquired CT transmission for localization).

"Plain x-ray is indicated as the initial imaging study"