Musculoskeletal Imaging Guidelines

This policy covers musculoskeletal imaging — including plain radiography and advanced imaging (CT, MRI, tomographic studies) — for a wide range of conditions such as fractures, avascular necrosis/osteonecrosis, infection/osteomyelitis, gout/CPPD, osteoarthritis and inflammatory arthritis (RA), tendon/muscle injuries, chondral/osteochondral lesions, osteoporosis, soft‑tissue masses, post‑operative joint replacement, and region‑specific shoulder/elbow/wrist/hand indications. Major limitations require an initial face‑to‑face clinical evaluation within 60 days, plain X‑rays after symptom onset/change prior to advanced imaging, documentation of failure of a recent six‑week trial of provider‑directed conservative therapy with clinical re‑evaluation (within 3 months) for advanced imaging, and physician review for atypical presentations; routine serial advanced imaging is generally not supported.

"CT/CTA | CPT ®"