Preface to the Imaging Guidelines
EVICORE-PREFACE_IMAGING_GUIDELINES
eviCore’s Preface endorses evidence‑based use of US, CT, MRI and PET/CT for specified indications (e.g., US for obstetric/soft‑tissue/vascular/procedural use; CT for trauma, pulmonary, abdominal/pelvic viscera and complex fractures; MRI for CNS, soft‑tissue/musculoskeletal and pregnancy/high‑radiation‑sensitivity cases; PET/CT for oncologic, cardiac and brain metabolic imaging with supported tracers) while generally not supporting whole‑body screening CT for asymptomatic individuals, most WBMRI and PET‑MRI (except narrow cancer‑predisposition, select autoimmune/pediatric or when PET‑CT is unavailable), investigational quantitative mp‑MRI procedures, and certain specialized tracers or unbundled PET/CT billing. Key requirements: Medicare/CMS coverage takes precedence for Medicare enrollees, prior authorization requires submission of pertinent clinical documentation (recent history, exam, labs, prior imaging and condition‑specific info) to establish medical necessity, and providers must follow specified coding/contrast/renal/pregnancy and guidance‑code billing restrictions.