Lumbar MRI

Lumbar MRI is covered when clinically necessary to evaluate suspected spinal cord compression, neoplasm, infection (including osteomyelitis), myelopathy, significant/progressive neurologic deficits, or when imaging is required for surgical or aggressive treatment planning. For uncomplicated low back pain without red flags, imaging is not recommended in the first month and is covered only after at least a four-week trial of conservative management; coverage is limited to FDA-approved MRI units and investigational MRI uses (e.g., MR spectroscopy, blood flow measurement, cortical bone imaging) are not covered. Documentation must demonstrate medical necessity (history, focused neurologic exam, conservative trial when applicable) and written reports must address relevant clinical issues and comparative data.

"Lumbar MRI is covered to evaluate suspected spinal cord compression, including diagnosis and localization of spinal cord compression."