Musculoskeletal Imaging Guidelines

This policy covers musculoskeletal imaging services — including plain radiography, tomographic studies (e.g., SPECT and SPECT/CT) and anatomic-area–specific advanced imaging — for common musculoskeletal symptoms and conditions such as avascular necrosis/osteonecrosis, fractures, infection/osteomyelitis, gout/CPPD, soft‑tissue masses, tendon/muscle injuries, osteoarthritis, inflammatory arthritis, osteoporosis, post‑operative joint replacement evaluation, limb‑length discrepancy and related indications. Major requirements/limitations include an in‑person clinical evaluation and clinical re‑evaluation after failed conservative therapy, availability of plain x‑rays performed after the current episode before advanced imaging is considered, physician review for atypical presentations, and specified SPECT/SPECT‑CT technical criteria (concurrent CT acquisition and minimum two‑area or multi‑day protocols).

"Diagnosis of primary bone cancer"