Musculoskeletal MSK Imaging Guidelines

This policy governs musculoskeletal imaging services — including plain radiography, CT, MRI (e.g., CPT 73218/73219) and related techniques/3D rendering — for common conditions such as fractures, avascular necrosis/osteonecrosis, infection/osteomyelitis, osteoarthritis and inflammatory arthritis, gout/CPPD, soft‑tissue masses, tendon/muscle injuries, post‑operative joint replacement assessment, osteoporosis and other anatomic‑area‑specific disorders. Major limits require an initial plain X‑ray before advanced imaging, a recent face‑to‑face clinical evaluation (within 60 days) and documentation of failure of a six‑week provider‑directed conservative treatment with re‑evaluation (usually within 3 months); serial advanced imaging is generally not supported and positional MRI/dGEMRIC are considered experimental/investigational.

"Infection / Osteomyelitis"

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