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January 25, 2018


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Medical Coding News Archives

CMS Expands MRI Coverage

 
October 27, 2009:

A wording change in the national coverage determination for magnetic resonance procedures (MRI) means that contractors can decide coverage for four procedures.

Effective September 28, 2009, the Centers for Medicare and Medicaid Services (CMS) removed the phrase “blood flow measurement” from the national coverage decision for MRI, thereby giving individual contractors the opportunity to make coverage decisions for the following procedures: 

75558  Cardiac MRI for morphology/function w/o contrast materials; w/flow/velocity quantification
75560  Cardiac MRI for morphology/function w/o contrast materials; w/flow/velocity quantification & stress
75562  Cardiac MRI for morphology/function w/o contrast materials; followed by contrast materials/further sequences, w/flow/velocity quantification
75564  Cardiac MRI for morphology/function w/o contrast materials; followed by contrast materials/further sequences, w/flow/velocity quantification & stress.

The above codes will also appear in the January 2010 Integrated Outpatient Code Editor (IOCE) quarterly updates.

As with all Medicare covered services, providers will be required to substantiate the medical necessity of the procedure before payment is made. Other MRI procedures, such as cortical bone imaging and spatial resolution of bone and calcifications, remain noncovered. In addition, CMS reviewed a coverage request that would allow MRIs for patients with pacemakers or metallic clips on aneurysms. However, there is no evidence corroborating the claim that use of MRI improves health outcomes in beneficiaries who have a Food and Drug Administration-approved implanted cardioverter-defibrillator or cardiac pacemaker designed for use in the MRI environment. Specific coverage guidelines for MRI procedures can be found in the National Coverage Determinations Manual, Pub 100-3 Section 220.

Deborah C. Hall
Clinical/Technical Editor

 

 
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