Diagnostic Imaging - Medicare Advantage

This Humana Medicare Advantage diagnostic imaging policy states that imaging services (CT, MRI, MRA, PET, SPECT, etc.) are covered when reasonable and necessary per Medicare and applicable NCDs/LCDs. It provides explicit medical necessity criteria for brain MRI in patients prescribed Leqembi (lecanemab-irmb) — prior to initiation (within 1 year), prior to the 3rd/5th/7th/14th infusions, or for signs/symptoms suggestive of ARIA — and identifies certain HCPCS codes (S8037, S8042) as not covered.

"Diagnostic imaging services (CT, CTA, MRI, MRA, CMR, PET, PET/CT, PET/MRI, SPECT) that are reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functionin..."

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