

Guidelines and CPT codes for ordering MRI exams based on patient symptoms.
| BODY PART | REASON FOR EXAM | PROCEDURE TO PRE-CERT | CPT CODE |
| Spine: Cervical | Arm/Shoulder Pain and/or Weakness Degenerative Disease Neck Pain Disk Herniation Post-Op Fusion Radiculopathy Syrinx |
MRI Cervical Spine Without Contrast | 74141 |
| Discitis Osteomyelitis Multiple Sclerosis Myelopathy Tumor/Mass/Cancer/Mets Vascular Lesions AVM |
MRI Cervical Spine Without and With Contrast | 72156 | |
| Spine: Thoracic | Back Pain Compression Fx (no malig/mets) Degenerative Disease Disk Herniation Radicuolpathy Trauma Vertebroplasty Planning (w/no hx malig) |
MRI Thoracic Spine Without Contrast | 72146 |
| Compression Fx (no malig/mets) Discitis Osteomyelitis Multiple Sclerosis Myelopathy Syrinx Tumor/Mass/Cancer/Mets Vascular Lesions AVM Vertebroplasty Planning (w/no hx malig) |
MRI Thoracic Spine Without and With Contrast | 72157 | |
| Spine: Lumbar | Back Pain Compression Fx (no malig/mets) Degenerative Disease Disk Herniation Radicuolpathy Sciatica Spondylolisthesis Stenosis Trauma Vertebroplasty Planning (w/no hx malig) |
MRI Lumbar Spine Without Contrast | 72148 |
| Compression Fx (no malig/mets) Discitis Osteomyelitis Post-Op Tumor/Mass/Cancer/Mets Vertebroplasty (w/no hx malig) |
MRI Lumbar Spine Without and With Contrast | 72158 |