CMS Local Coverage Determination (LCD)

CMS Magnetic Resonance Imaging of the Orbit, Face, and/or Neck Form


MRI of the Orbit, Face, and/or Neck

Indications

(434643) Is the MRI intended to diagnose or characterize pathology of the eye, nasopharynx, oropharynx, or neck including tumors, infection, soft tissue pathologies, and congenital abnormalities? 
(434644) Is the MRI for a patient who has experienced trauma to the orbit, face, and/or neck? 
(434645) Is a concurrent MRI of the brain ordered on the same day as the MRI of the orbit, face, and/or neck, and is the medical necessity for both procedures documented in the medical record? 
(434646) Is the initial imaging of the thyroid for a known carcinoma case? 

Contraindications

(434647) Does the patient have implanted neurostimulators or cochlear implants? 
(434648) Does the patient have cardiac pacemakers, metal fragments in the eye, magnetic ocular implants, or older ferromagnetic intracranial aneurysm clips? 
(434649) Is the MRI performed only for measuring blood flow and spectroscopy, imaging of cortical bone and calcifications, or procedures involving spatial resolution of bone or calcifications? 
Effective Date

09/09/2021

Last Reviewed

09/03/2021

Original Document

  Reference



Background for this Policy

Summary Of Evidence

N/A

Analysis of Evidence

N/A

Magnetic Resonance Imaging (MRI) is a noninvasive diagnostic imaging modality used to diagnose a variety of central nervous system (CNS) disorders. MRI provides superior tissue contrast when compared to a Computerized Tomography (CT) scan, is able to image in multiple planes, is not affected by bone artifact, provides vascular imaging capability, and makes use of safer contrast media (gadolinium chelate agents). Its major disadvantage over a CT scan is the longer scanning time required for study, making it less useful for emergency evaluations. Contraindications include patients with implanted neurostimulators or cochlear implants. Potential contraindications may include patients with cardiac pacemakers (refer to the CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, ยง220.2), metal fragments in the eye, magnetic ocular implants or patients with older ferromagnetic intracranial aneurysm clips. All of these objects may be potentially displaced when exposed to the powerful magnetic fields used in MRI.

MRI of the orbit, face, and/or neck may be considered medically reasonable and necessary when used to diagnose and characterize pathology of the eye, nasopharynx, oropharynx, and neck including tumors, infection, soft tissue pathologies, and congenital abnormalities. In cases involving trauma to the orbit, face and/or neck, a CT scan is frequently superior to MRI for assessing injury.

MRI is considered investigational when medical records document the service was performed only for one of the following:

    • measurement of blood flow and spectroscopy,
    • imaging of cortical bone and calcifications, and
    • procedures involving spatial resolution of bone or calcifications.


In some instances, ordering a MRI of the brain in addition to a MRI of the orbit, face, and/or neck may be medically necessary on the same day. The medical record should document the medical necessity for these two procedures being performed on the same day.

Initial imaging of the thyroid should be done with ultrasound or nuclear medicine, unless there is a known carcinoma present.