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eviCore Spine Imaging Guidelines

Spine Imaging Policy Version Effective September 1 , 2021eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual s Primary Care Physician (PCP) may provide additional insight. CPT (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT five digit codes, nomenclature and other data are copyright 2021 American Medical Association.

review, localization and determination/detection of pathology, single area (e.g., head, neck, chest, pelvis), single day imaging 78830 : Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas

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  Guidelines, Imaging, Spine, Spine imaging guidelines, Localization

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