Spine Imaging Guidelines

This policy covers advanced spine imaging—MRI, CT, nuclear medicine and related planar/tomographic studies of the cervical, thoracic and lumbar spine—for evaluation of spinal disorders. It applies to patients with neck/back pain (with or without neurologic features), radiculopathy, myelopathy, stenosis, spondylolysis/spondylolisthesis, deformity, post‑operative conditions, pathological fractures, cancer‑related spinal pain and other spinal canal/cord disorders, and requires a prior face‑to‑face clinical evaluation, a plain x‑ray after the current symptom episode, a documented clinical re‑evaluation showing failure of a six‑week trial of provider‑directed conservative therapy (within 3 months), with physician review and specific documentation required for atypical, repeat or simultaneous studies.

"Spinal Pain in Cancer Patients"

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