Preface to the Imaging Guidelines

This policy provides prefatory, evidence‑based guidance for authorization and use of advanced imaging and related procedures — including MRI, CT, PET, nuclear medicine, ultrasound, radiation oncology, sleep studies, and cardiac and spine interventions — for evaluation of common symptoms and symptom complexes. Major limitations/requirements include that specific Health Plan and CMS coverage takes precedence, a current clinical evaluation (generally within 60 days) is required before ordering advanced imaging (with x‑rays required for spine/musculoskeletal episodes), atypical or investigational presentations need physician review, and clinician judgment may override the guidelines.

"Evaluation of Sleep Studies"

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