Advanced Imaging of the Spine - Medicare Advantage

This Humana Medicare Advantage medical coverage article endorses application of applicable CMS NCDs/LCDs and specifies clinical scenarios where advanced spinal imaging (CT, MRI, MRA) is medically reasonable and necessary. Key requirements include documented red flags, reason MRI cannot be obtained (for CT), and, for low back pain, failure of four weeks of conservative therapy prior to MRI in the absence of other indications; services not meeting listed criteria are considered not medically necessary.

"History of cancer (as a red flag for CT in lumbar/thoracic back pain)."

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