Head Imaging Guidelines

The eviCore Head Imaging guideline approves advanced head imaging (CT, MRI, CTA/MRA, PET/SPECT, perfusion, fMRI, etc.) for numerous specified neurologic indications but excludes routine imaging for uncomplicated primary headaches and treats amyloid PET as investigational (reimbursable only via CMS Coverage with Evidence Development) with many other dementia PET uses and non‑FDG brain perfusion PET non‑covered. Key requirements include a recent (≤60 days) face‑to‑face evaluation with neurologic exam (exceptions limited), condition‑specific documentation and labs (e.g., pituitary labs within 6 weeks, cognitive testing thresholds for dementia, MS workup, Canadian CT Head Rule for trauma), and medical‑director or specialist ordering/review for certain studies (fMRI, some pituitary/surgical planning, amyloid PET).

"For epistaxis imaging: documentation of endoscopic findings of a mass lesion during ENT exam (all epistaxis cases forwarded for MD review)."