Musculoskeletal Imaging Guidelines

These Musculoskeletal Imaging Guidelines cover musculoskeletal imaging services (plain radiography, CT, MRI/MRA, SPECT, and 3D rendering) for evaluation of a wide range of conditions and anatomic areas, including fractures, avascular necrosis/osteonecrosis, infection/osteomyelitis, osteoarthritis, rheumatoid and other inflammatory arthritides, soft‑tissue masses, muscle/tendon injuries, post‑operative joint replacement assessment, and limb‑length discrepancy. Major requirements include an in‑person clinical evaluation with relevant history/physical and appropriate labs, plain x‑rays performed after symptom onset/change before advanced imaging, clinical re‑evaluation after failed conservative treatment, physician review for atypical presentations, adherence to proprietary Clinical Review Criteria, and use of specified CPT coding/area limitations.

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