Musculoskeletal Imaging Guidelines

Evicore covers advanced musculoskeletal imaging (MRI, CT, ultrasound, selected nuclear studies) for specific body‑region indications (eg, occult/stress fractures, AVN, infection, soft‑tissue masses, complex fractures/preop planning) and excludes or labels investigational modalities such as positional MRI, dGEMRIC, and routine PET, while also deeming MRI not medically necessary for isolated muscle‑belly strains and many ganglions/CPPD. Key requirements: an initial face‑to‑face evaluation within 60 days, a current plain radiograph before advanced imaging in most cases, and documented failure of a provider‑directed 6‑week conservative trial within the past 12 weeks (with specified acute/surgical exceptions) plus indication‑specific clinical/lab documentation.

"Complex Fracture (hand) — CT Hand or Finger without contrast (CPT® 73200) when plain x-ray shows a complex fracture."