Spine Imaging Guidelines

This policy covers spine imaging procedures—plain radiographs, CT, MRI and related advanced diagnostic studies—for evaluation of cervical, thoracic and lumbar spine conditions such as neck/back pain, radiculopathy and neuropathy, myelopathy, spondylolysis/spondylolisthesis, spinal stenosis, sacro‑iliac disease, spinal deformity, pathological compression fractures, post‑operative spine disorders and cancer‑related spinal disease. Major requirements/limitations include an initial face‑to‑face clinical evaluation (within 60 days before advanced imaging), a documented clinical re‑evaluation showing failure of a recent six‑week provider‑directed conservative trial (re‑evaluation may be face‑to‑face or other meaningful contact), timing of plain x‑rays where required, and physician review for atypical presentations or requests outside the guideline indications, with advanced imaging primarily reserved for red‑flag conditions or failed conservative management.

"SP-7: Myelopathy"