MRI and CT Scans of the Head and Neck

This LCD covers standard CT and MRI of the head and neck when medically necessary based on documented symptoms and a provisional diagnosis; CT is preferred when MRI is contraindicated (e.g., pacemaker, intracranial metal, extreme obesity, inability to lie still) or when fine bone detail is needed. Contrast-enhanced CT is indicated for perfusion assessment, lesion characterization, blood-brain-barrier defects, neovascularity, and staging for cancers that commonly metastasize to the brain; multiple contrast CTs per episode are generally not allowed except for listed cerebrovascular, hemorrhagic, postoperative, or tumor-change indications. Coverage is limited to FDA pre-market approved CT/MRI equipment, providers must follow applicable NCDs/CMS instructions, and staging brain scans are not covered for cancers that almost never metastasize to the brain (esophagus, oropharynx, prostate, non-melanoma skin cancer) absent neurologic signs.

"CT scan is reasonable and necessary when medically appropriate given the patient’s symptoms and preliminary (provisional) diagnosis."