Spine Imaging Guidelines

This policy covers spine imaging guidelines and associated procedures, including MRI of the cervical, thoracic, and lumbar spine (with/without contrast) and relevant nuclear/SPECT CPT codes for evaluation of spinal disorders. It applies to common spine complaints such as neck, thoracic and low back pain, radiculopathy/neuropathy, myelopathy, lumbar spondylolysis/spondylolisthesis, spinal stenosis, sacro‑iliac disorders, pathological compression fractures, cancer‑related spinal pain, inflammatory spondylitis/sacroiliitis and related conditions. Major limitations include physician review for atypical presentations, documented in‑person evaluation and a clinical re‑evaluation after failed conservative therapy before advanced imaging is considered, and CPT‑specific constraints for SPECT/planar studies (e.g., single‑day versus multi‑day area requirements).

"Any bowel/bladder abnormalities or emergent or urgent indications should be documented at the time of the initial clinical evaluation and clinical re-evaluation."