Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.
"Current Procedural Terminology © American Medical Association. All Rights Reserved"
History From 2024 Forward
| 12/02/2024 |
Annual review, policy updated for clarity and consistency. Adding -Genetic syndromes and rare disease section- reorganized indications - Note: Vessel wall MRI (ordered as Brain MRI) can also be performed in the evaluation of vasculitides - PML suspected or known to the infectious or inflammatory disease section. - And updated Brain MRI for Known Cancer sections (initial staging, restaging and surveillance) - Vertigo with progressive unilateral hearing loss or tinnitus Horner’s syndrome with symptoms localizing the lesion to the central nervous system (Brain/Cervical MRI Combo) - Known Moyamoya disease or eversible cerebral vasoconstriction with any new or changing neurological signs or symptoms (also to (Brain MRA /MRI combo) - Suspected secondary CNS vasculitis based on neurological signs or symptoms in the setting of an underlying systemic disease with abnormal inflammatory markers or autoimmune antibodies (Brain MRA /MRI combo) - Suspected primary CNS vasculitis based on neurological signs and symptoms with completed infectious/inflammatory lab work-up ((Brain MRA /MRI combo)) - Giant cell arteritis with suspected intracranial and extracranial involvement (Brain MRA /Neck/ Brain MRI combo)) Clarified - Updated pediatric seizure section. - Treatment of Alzheimer's disease with anti-amyloid-β monoclonal antibodies - baseline and surveillance imaging as per FDA labeling. Also updating description, references and combination section. Adding purpose |
| 01/01/2024 |
New Policy |
