Humana Videofluoroscopy, Dynamic MRI for Musculoskeletal Indications - Medicare Advantage Form
This procedure is not covered
Please refer to CMS website for the most current applicable CMS Online Manual System (IOMs)/National Coverage Determination (NCD)/ Local Coverage Determination (LCD)/Local Coverage Article (LCA)/ Transmittals.
There are no NCDs and/or LCDs for videofluoroscopy or dynamic MRI for musculoskeletal indications.
Videofluoroscopy, Dynamic MRI for Musculoskeletal Indications
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Description
Fluoroscopy is a type of radiographic imaging that shows the movement of a body part or movement of a contrast agent through the body. When used for musculoskeletal indications, it may be utilized to evaluate the entire spine, the movement of joints and other areas of the skeletal system. In videofluoroscopy (also known as cineradiography), fluoroscopic imaging is recorded to allow for repeated viewing at varying speeds, purportedly to aid in determining the area of joint dysfunction.
Digital motion x-rays are screen-film or computer-based snapshots taken in sequence as the individual moves through various positions. The digitized images are ordered sequentially using a computer program to simulate a moving image of the inside of the body.
Dynamic visualization describes several different imaging techniques including videofluoroscopy, vertebral motion analysis and digital motion x-ray. Vertebral motion analysis uses imaging similar to dynamic visualization with the addition of controlled movement and computerized tracking analysis.
Dynamic (kinematic) or upright magnetic resonance imaging (MRI) purportedly provides images of the spine under daily living or weight-bearing conditions. A vertically open configuration MRI enables sitting or standing during image capture. Position changes, such as flexion and extension of the neck or back can also be viewed.
Coverage Determination
Humana follows the CMS requirements that only allows coverage and payment for services that are reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member except as specifically allowed by Medicare.
In interpreting or supplementing the criteria above and in order to determine medical necessity consistently, Humana may consider the following criteria.
Videofluoroscopy, Dynamic MRI for Musculoskeletal Indications
The use of the criteria in this Medicare Advantage Medical Coverage Policy provides clinical benefits highly likely to outweigh any clinical harms. Services that do not meet the criteria above are not medically necessary and thus do not provide a clinical benefit. Medically unnecessary services carry risks of adverse outcomes and may interfere with the pursuit of other treatments which have demonstrated efficacy.
Coverage Limitations
US Government Publishing Office. Electronic code of federal regulations: part 411 – 42 CFR § 411.15 - Particular services excluded from coverage