Spine Imaging Guidelines

eviCore authorizes advanced spinal imaging (MRI, CT, CT/myelography, and select nuclear studies) as medically necessary for indications such as disc disease, spinal cord/nerve root disorders, trauma, infection, neoplasm, cauda equina and other specified conditions, but considers MR spectroscopy, positional/weight‑bearing MRI, routine spine PET (except for neoplastic workup), cone‑beam CT for the cervical spine, and adult spinal canal ultrasound experimental/investigational. Key requirements include a face‑to‑face clinical evaluation within 60 days, documentation of failure of a recent (within 3 months) six‑week trial of provider‑directed conservative therapy (unless red flags are present), detailed neurologic exam findings (motor 0–5 grading, dermatomal sensory changes, reflexes), plain x‑rays when required, and adherence to specific documentation and modality‑specific conditions.

"CT/Myelography indications include: Preoperative planning for spine surgery when MRI is insufficient, equivocal, indeterminate or non-diagnostic."