Musculoskeletal Imaging Guidelines

This policy covers musculoskeletal diagnostic imaging—ranging from plain radiographs to advanced modalities and tomographic SPECT/SPECT‑CT—for common musculoskeletal symptoms and conditions such as avascular necrosis, fractures, infection/osteomyelitis, gout/CPPD, osteoarthritis, inflammatory arthritis, soft‑tissue masses, tendon/muscle injuries, post‑operative joint replacement and various anatomic sites (e.g., shoulder, elbow, wrist, hand). Major limitations: atypical presentations not in the tool require physician review; advanced imaging generally requires an initial in‑person clinical evaluation, available post‑episode plain x‑rays, and a clinical re‑evaluation after a failed trial of conservative therapy, and SPECT studies must meet CPT‑specified SPECT vs SPECT‑CT protocol requirements.

"Advanced imaging studies for musculoskeletal conditions (i."

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