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DESCRIPTIONPositional magnetic resonance imaging (MRI) allows imaging of the patient in various positions, including sitting and standing. This technology is being evaluated for the diagnosis of patients with position-dependent back pain.
Determining the cause of back pain is a complex task. In some patients, extensive evaluation with various imaging modalities does not lead to a definitive diagnosis. Some recent studies have suggested that imaging the body in various positions with “loading” of the spine may lead to more accurate diagnosis. This loading can be accomplished by having the patient stand upright or sit. Also, imaging can be completed with the patient in the position that causes the symptom(s). This is being evaluated in suspected nerve root compression and in some cases of spondylolisthesis.
A new open magnetic resonance imaging (MRI) system has been developed that allows imaging of the patient in various positions. The imaging can be conducted with partial or full weight bearing. Dynamic-kinetic imaging (images obtained during movement) can also be obtained with this system. Conventional MR imaging is completed with the patient in a recumbent position. Of note, weight-bearing images of the spine can be simulated by imaging in the supine position in combination with a special axial loading device.
FONAR Corporation has 510(k) marketing clearance from the U. S. Food and Drug Administration (FDA) for a MRI system that performs positional MRI scans (i.e., FONAR’s Upright® MRI).
POLICYPositional (non-recumbent) magnetic resonance imaging (MRI) is considered investigational, including its use in the evaluation of patients with cervical, thoracic, or lumbosacral back pain.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY5/6/2008: Policy added
4/27/2009: Policy reviewed, no changes
04/27/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
06/21/2011: Policy reviewed; no changes.
05/09/2012: Policy reviewed; no changes.
08/07/2013: Policy reviewed; no changes.
SOURCE(S)Blue Cross & Blue Shield Association Policy # 6.01.48
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.