Musculoskeletal Imaging Guidelines

This policy covers advanced musculoskeletal imaging—primarily MRI and CT (and related coding for computer‑assisted navigation, e.g. +0055T)—for evaluation of bone, joint and soft‑tissue pain or injury, including suspected fractures, dislocations, osteomyelitis, tumors, osteoarthritis and other musculoskeletal conditions. Coverage requires a clinical evaluation within 60 days (history, physical, appropriate labs and prior non‑advanced imaging), generally mandates a plain radiograph after the current episode before advanced imaging (unless an exception applies), expects consideration of conservative non‑surgical care, limits routine use of contrast to specific indications (tumors/osteomyelitis, MR arthrography), and does not support serial surveillance imaging in most cases.

"Pelvic/acetabulum fractures."

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