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Medicare will consider Magnetic Resonance Imaging of the Brain medically reasonable and necessary when used to aid in the diagnosis of lesions of the brain and to assist in therapeutic decision making in the following conditions:
• For detecting or evaluating extra-axial tumors, A-V malformations, cavernous hemangiomas, small intracranial aneurysms, cranial nerve lesions, demyelination disorders including multiple sclerosis, lesions near dense bone, acoustic neuromas, pituitary lesions, and brain radiation injuries;
• For development abnormalities of the brain including neuroectodermal dysplasia;
• For subacute central nervous system hemorrhage or hematoma;
• For acute cerebrovascular accidents;
• For complex partial seizures, seizures refractory to therapy, temporal lobe epilepsy, or other atypical seizure disorders;
• MRI is usually not the procedure of choice in patients who have acute head trauma, acute intracranial bleeding, or investigation of skull fracture or other bone abnormality, or as follow-up for hydrocephalus. However, a MRI may be necessary in patients whose presentation indicates a focal problem or who have had a recent significant change in symptomatology;
• For brain infections;
• Where soft tissue contrast is necessary;
• When bone artifacts limit CT, or coronal, coronosagittal or parasagittal images are desired; [and]
• For procedures in which iodinated contrast material are contraindicated.
Contraindications:
The MRI is not covered when the following patient-specific contraindications are present:
• MRI is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms unless the Medicare beneficiary meets the provisions.
Coverage determination L28904 for magnetic resonance imaging includes coverage guidelines (shown above). Which of the following is NOT supported in these guidelines?
A. MRI is considered medical reasonable and necessary when used to aid in the diagnosis of lesions of the brain if a patient has a subacute central nervous system hemorrhage.
B. Medicare covers MRI for patients with pacemakers.
C. MRI is usually not the procedure of choice in patients with head trauma.
D. MRI will be considered reasonable and necessary for patient with acute cerebrovascular accidents.