Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers hospital outpatient MRI/CT only for specific clinical or logistical reasons (e.g., required clinical trial protocol/equipment, imaging within 24 hours of a hospital specialist visit or a planned procedure, contrast allergy, need for identical prior-study protocol/equipment for active disease or restaging, obstetrical/perinatology care, pediatric patients, or when no geographically accessible alternative such as required sedation/anesthesia, equipment size, or open MRI) and considers all other hospital outpatient MRI/CT (including cancer screening, initial cancer staging, many non-cancer musculoskeletal studies, and surveillance without clinical suspicion) not medically necessary. Coverage requires medical-record documentation of the applicable criterion(s) (which does not guarantee payment), emergency/observation/urgent care/inpatient imaging does not require authorization, and the policy applies to UnitedHealthcare Commercial and Individual Exchange plans with certain state exclusions.