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FUTURE Local Coverage Determination (LCD)

Magnetic Resonance Angiography

L34424

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Proposed LCD
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Future Effective
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Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34424
Original ICD-9 LCD ID
Not Applicable
LCD Title
Magnetic Resonance Angiography
Proposed LCD in Comment Period
N/A
Source Proposed LCD
DL34424
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 01/26/2025
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
12/12/2024
Notice Period End Date
01/25/2025

CPT codes, descriptions, and other data only are copyright 2024 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2024 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.
Issue - Explanation of Change Between Proposed LCD and Final LCD

No changes between Proposed LCD and Final LCD.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(1)(E) excludes expenses for items or services which are not reasonable and necessary to carry out research conducted pursuant to §1142 of the Act.

Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups.

42 CFR §410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §20 Services Not Reasonable and Necessary

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.2 Magnetic Resonance Imaging (MRI).

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Magnetic resonance angiography (MRA) is a modern diagnostic technique based on the effect of nuclear magnetic resonance and is like magnetic resonance imaging (MRI). During the procedure, the device reads electromagnetic waves received during the oscillation of the nuclei of hydrogen atoms, after which the computer converts the information received into a three-dimensional image of the zone under study. MRA is utilized to carry out studies of arteries, veins and lymphatic vessels of any location, to carry out a detailed assessment of the state of vascular networks, to identify pathological changes in the early stages, and to determine the cause of the pathology.1

The coverage criteria and definition of MRA are found in the CMS Internet-only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.2. MRA with or without contrast is considered appropriate when it can replace a more invasive test (e.g., contrast angiography) and reduce risk for beneficiaries. MRA is a covered indication for various diseases and abnormalities involving the arterial, venous and lymphatic systems. In addition, the services must be reasonable and necessary for the diagnosis or treatment of the specific patient involved.

The use of MRA would have the same contraindications as MRI and should not be used in patients with implanted ferromagnetic structures and electronic devices.
Summary of Evidence

MRA encompasses several imaging techniques based on MRI developed for studying the arterial and venous systems. The benefits of an MRA in comparison to traditional angiography is that it is noninvasive, it lacks ionizing radiation exposure, it has the potential for a non-contrast examination, and it can produce high-resolution volumetric images. The MRA gadolinium contrast material is less likely to cause an allergic reaction than the iodine-based contrast materials used for computed tomography scanning.

An MRA is often indicated to evaluate the following abnormalities and conditions and is used for screening1 and monitoring purposes1: arterial aneurysm(s)1, arteriovenous malformations2-4, aortic coarctation1, aortic dissection5,6, cerebral stroke1, carotid artery disease7,8, peripheral atherosclerosis of the extremities1, congenital heart disease1, coronary artery disease and, if indicated, graft patency9-12, mesentery artery ischemia13,14, renal artery stenosis15, pulmonary embolism16,17, trigeminal neuralgia18-20, moyamoya disease21,22 and intracranial aneurysms.23,24

MRA has the same contraindications as MRI, including patients with implanted ferromagnetic structures and electronic devices. Such devices might include, but are not limited to the following: a cardiac implantable electronic device, mechanical metallic heart valves, metallic foreign bodies, implantable neurostimulation system, cochlear implants/ear implant, non-removable drug infusion pumps, catheters with metallic components, cerebral artery aneurysm clips which are non-MRI compatible, and tissue expanders with magnetic infusion ports.25 Other contraindications for use of the contrast medium include a previous allergic or anaphylactic reaction to gadolinium.26
Analysis of Evidence (Rationale for Determination)

MRA of cerebral vessels is useful to create detailed three-dimensional images of vascular networks and surrounding brain tissues, identify hematomas, hemorrhages, aneurysms, arteriovenous shunts and areas of circulatory disorders. MRI angiography is indicated for suspected post-traumatic intracranial hematoma, stroke, chronic cerebral ischemia with vertebrobasilar insufficiency, encephalopathy, post-traumatic or post-stroke changes, as well as with vegetative-vascular dystonia, pituitary adenoma, Parkinson’s disease and some other pathological conditions. The study can be both with and without contrast.

MRA of the vessels of the extremities is utilized to determine the structure of vascular networks, the condition, localization and interposition of the arteries and veins of the extremities, as well as hemodynamic parameters in unchanged areas and areas of pathological changes. MRA is used for atherosclerosis, vasculitis, thrombosis, chronic venous insufficiency, angiopathies of various genesis, traumatic injuries of arteries and veins, compression or germination of vessels by neoplasms, aneurysms, malformations and vascular dysplasia of the extremities. In some cases, contrast-free MRA is performed. When indicated, gadolinium contrast is used.

MRA of mesenteric vessels is performed to recreate a complete picture of the localization and structure of the abdominal aorta and the vessels departing from it and to identify various pathological changes (structural abnormalities, stenosis, occlusion, traumatic injury, etc.). MRA is prescribed for circulatory disorders in the abdominal aorta basin, with suspicion of abdominal aorta coarctation, atherosclerotic lesion of abdominal vessels, aneurysm aorta, malformations and vascular ruptures of traumatic origin. Vascular contrast can be used to increase the informative value of MRA.

MRA of the lymphatic system makes it possible to assess the condition of the entire lymphatic system and its individual areas. During the procedure, lymph nodes and large collectors are examined. A determination of the level of fluid content in tissues can be made and conclusions about the degree of disruption of lymphatic drainage function can be ascertained. MRA is used for lymphedema caused by inflammatory processes, oncological lesions and fibrous changes that have arisen as a result of previously treated and untreated diseases.27

In addition, when utilized to make a diagnosis, MRA of the spinal vessels, MRA of the heart and coronary vessels, MRA of the thoracic aorta and several other studies may also be indicated.

Based upon the evidence reviewed, there may be other indications for MRA due to its utility to detect abnormalities involving the blood vessels and lymphatic system. Therefore, MRA is considered reasonable and necessary with and without contrast agent to assess any of the above indications and can be used for other vascular abnormalities when clinical indications are reasonable and necessary.

Proposed Process Information

Synopsis of Changes
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Associated Information
Sources of Information
Bibliography
Open Meetings
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Contractor Advisory Committee (CAC) Meetings
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MAC Meeting Information URLs
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Requestor Information
This request was MAC initiated.
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

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CPT/HCPCS Codes

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ICD-10-CM Codes that Support Medical Necessity

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Group 1

Group 1 Paragraph:

N/A

 Group 1 Codes:

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N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

Group 1 Paragraph:

N/A

 Group 1 Codes:

N/A

N/A

Additional ICD-10 Information

General Information

Associated Information

Utilization Guidelines

Medicare will allow coverage of MRIs for patients with implanted permanent pacemakers when used according to the Food and Drug Administration's (FDA) approved labeling for use in an MRI environment.
Sources of Information
N/A
Bibliography
  1. Lim RP, Koktzoglou I. Noncontrast magnetic resonance angiography: Concepts and clinical applications. Radiol Clin North Am. 2015;53(3):457-476.
  2. Arai N, Akiyama T, Fujiwara K, et al. Silent MRA: Arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation. Neuroradiology. 2020;62(4):455-461.
  3. Brunozzi D, Hussein AE, Shakur SF, et al. Contrast time-density time on digital subtraction angiography correlates with cerebral arteriovenous malformation flow measured by quantitative magnetic resonance angiography, angioarchitecture, and hemorrhage. Neurosurgery. 2018;83(2):210-216.
  4. Cheng YC, Chen HC, Wu CH,et al. Magnetic resonance angiography in the diagnosis of cerebral arteriovenous malformation and dural arteriovenous fistulas: Comparison of time-resolved magnetic resonance angiography and three dimensional time-of-flight magnetic resonance angiography. Iran J Radiol. 2016;13(2):e19814.
  5. Baliga RR, Nienaber CA, Bossone E, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging. 2014;7(4):406-424.
  6. Kinner S, Eggebrecht H, Maderwald S, et al. Dynamic MR angiography in acute aortic dissection. J Magn Reson Imaging. 2015;42(2):505-514.
  7. Fellner C, Lang W, Janka R, Wutke R, Bautz W, Fellner FA. Magnetic resonance angiography of the carotid arteries using three different techniques: Accuracy compared with intraarterial x-ray angiography and endarterectomy specimens. J Magn Reson Imaging. 2005;21(4):424-431.
  8. Saxena A, Ng EY, Lim ST. Imaging modalities to diagnose carotid artery stenosis: Progress and prospect. Biomed Eng Online. 2019;18(1):66.
  9. Hajhosseiny R, Bustin A, Munoz C, et al. Coronary magnetic resonance angiography: Technical innovations leading us to the promised land? JACC Cardiovasc Imaging. 2020;13(12):2653-2672.
  10. Dai JW, Cao J, Lin L, Li X, Wang YN, Jin ZY. [Feasibility of non-contrast-enhanced coronary magnetic resonance angiography at 3.0T]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020;42(2):216-221.
  11. Henningsson M, Shome J, Bratis K, Vieira MS, Nagel E, Botnar RM. Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease. J Cardiovasc Magn Reson. 2017;19(1):68.
  12. Kato Y, Ambale-Venkatesh B, Kassai Y, et al. Non-contrast coronary magnetic resonance angiography: Current frontiers and future horizons. MAGMA. 2020;33(5):591-612.
  13. van Dijk LJ, van Petersen AS, Moelker A. Vascular imaging of the mesenteric vasculature. Best Pract Res Clin Gastroenterol. 2017;31(1):3-14.
  14. Hagspiel KD, Flors L, Hanley M, Norton PT. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18(1):2-13.
  15. Guo X, Gong Y, Wu Z, Yan F, Ding X, Xu X. Renal artery assessment with non-enhanced MR angiography versus digital subtraction angiography: Comparison between 1.5 and 3.0 T. Eur Radiol. 2020;30(3):1747-1754.
  16. Pressacco J, Papas K, Lambert J, et al. Magnetic resonance angiography imaging of pulmonary embolism using agents with blood pool properties as an alternative to computed tomography to avoid radiation exposure. Eur J Radiol. 2019;113:165-173.
  17. Ley S, Kauczor HU. MR imaging/magnetic resonance angiography of the pulmonary arteries and pulmonary thromboembolic disease. Magn Reson Imaging Clin N Am. 2008;16(2):263-273.
  18. Hao YB, Zhang WJ, Chen MJ, Chai Y, Zhang WH, Wei WB. Sensitivity of magnetic resonance tomographic angiography for detecting the degree of neurovascular compression in trigeminal neuralgia. Neurol Sci. 2020;41(10):2947-2951.
  19. Gamaleldin OA, Donia MM, Elsebaie NA, Abdelrazek AA, Rayan T, Khalifa MH. Role of fused three-dimensional time-of-flight magnetic resonance angiography and 3-dimensional T2-weighted imaging sequences in neurovascular compression. World Neurosurg. 2020;133:e180-e186.
  20. Docampo J, Gonzalez N, Muñoz A, Bravo F, Sarroca D, Morales C. Neurovascular study of the trigeminal nerve at 3 t MRI. Neuroradiol J. 2015;28(1):28-35.
  21. Savolainen M, Pekkola J, Mustanoja S, et al. Moyamoya angiopathy: Radiological follow-up findings in Finnish patients. J Neurol. 2020;267(8):2301-2306.
  22. Lehman VT, Cogswell PM, Rinaldo L, et al. Contemporary and emerging magnetic resonance imaging methods for evaluation of moyamoya disease. Neurosurg Focus. 2019;47(6):E6.
  23. Malhotra A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. MR angiography screening and surveillance for intracranial aneurysms in autosomal dominant polycystic kidney disease: A cost-effectiveness analysis. Radiology. 2019;291(2):400-408.
  24. Nielsen R, Hauerberg J, Munthe S, et al. [Screening for intracranial aneurysms]. Ugeskr Laeger. 2019;181(2).
  25. De Leucio A, De Jesus O. MR Angiogram. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
  26. Mallio CA, Rovira À, Parizel PM, Quattrocchi CC. Exposure to gadolinium and neurotoxicity: Current status of preclinical and clinical studies. Neuroradiology. 2020;62(8):925-934.
  27. Pamarthi V, Pabon-Ramos WM, Marnell V, Hurwitz LM. MRI of the central lymphatic system: Indications, imaging technique, and pre-procedural planning. Top Magn Reson Imaging. 2017;26(4):175-180.

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
01/26/2025 R13

This LCD is being presented for notice. No changes were made from the proposed LCD that was presented for comment.
  • Provider Education/Guidance
10/24/2019 R12

This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of this LCD and placed in the related Billing and Coding: Magnetic Resonance Angiography A56775 article.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
  • Provider Education/Guidance
08/01/2019 R11

All coding located in the Coding Information section has been moved into the related Billing and Coding: Magnetic Resonance Angiography A56775 article and removed from the LCD. Acronyms were inserted where appropriate throughout the LCD.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 
  • Provider Education/Guidance
10/01/2018 R10

Under ICD-10 Codes that Support Medical Necessity: Group 1 added ICD-10 codes I63.81, I63.89, I67.850 and I67.858. Under ICD-10 Codes that Support Medical Necessity: Group 1 deleted ICD-10 code I63.8. Under ICD-10 Codes that Support Medical Necessity: Group 1 the code description was revised for ICD-10 codes I63.333 and I63.343. Under ICD-10 Codes that Support Medical Necessity: Group 4 added ICD-10 code R93.89. Under ICD-10 Codes that Support Medical Necessity: Group 4 deleted ICD-10 code R93.8. This revision is due to the 2018 Annual ICD-10 Code Update and is effective on October 1, 2018.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
  • Revisions Due To ICD-10-CM Code Changes
04/12/2018 R9

Under CMS National Coverage Policy updated 42 CFR, Sec 410.32 with the most current information and corrected the title on the CMS Internet-Only Manual, Pub 100-03, Ch 1, Part 4, Sec 220.2. Under Bibliography changes were made to citations to reflect AMA citation guidelines and all American College of Radiology references were updated to the most current year.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
  • Provider Education/Guidance
01/29/2018 R8 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
  • Change in Affiliated Contract Numbers
10/01/2017 R7

Under ICD-10 Codes That Support Medical Necessity Group 1: Codes the code description was revised for I63.211, I63.212, I63.22, I63.323, I63.333, I63.513, I63.523, and I63.533. Under ICD-10 Codes That Support Medical Necessity Group 3: Codes added K91.30, K91.31 and K91.32. Under ICD-10 Codes That Support Medical Necessity Group 4: Codes deleted I27.2 and added I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.83 and R06.03. This revision is due to the 2017 Annual ICD-10 Updates.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
  • Provider Education/Guidance
  • Revisions Due To ICD-10-CM Code Changes
08/03/2017 R6

Under CPT/HCPCS Codes Group 1: Paragraph deleted codes 71555, 72198, 73225, 73725 and 74185 and added codes C8934, C8935 and C8936. Under CPT/HCPCS Group 2: Paragraph deleted 73725 from the verbiage “73725, C8912-C8914 Magnetic Resonance Angiography, Lower Extremity”. Under CPT/HCPCS Group 3: Paragraph deleted 74185 from the verbiage “74185, C8900-C8902 Magnetic Resonance Angiography, Abdomen”. Under CPT/HCPCS Group 4: Paragraph deleted 71555 from the verbiage “71555, C8909-C8911 Magnetic Resonance Angiography, Chest”. Under CPT/HCPCS Group 5: Paragraph deleted 72198 from the verbiage “72198, C8918-C8920 Magnetic Resonance Angiography, Pelvis”. Under CPT/HCPCS Group 6: Paragraph deleted the verbiage “73225, Magnetic resonance angiography, upper extremity, with or without contrast material(s)” and added the verbiage “C8934, C8935, C8936, Magnetic Resonance Angiography, Upper Extremity, with or without contrast”. Revisions due to codes no longer payable under Outpatient Prospective Payment System" (OPPS) as of July 01, 2017.

 

 
  • Provider Education/Guidance
05/29/2017 R5 No revisions were made as there were no comments received from the provider community.
  • Provider Education/Guidance
10/01/2016 R4 Under ICD-10 Codes That Support Medical Necessity Group 1: Codes added ICD-10 codes H59.331, H59.332, H59.333, H59.339, H59.341, H59.342, H59.343, H59.349, H59.351, H59.352, H59.353, H59.359, H59.361, H59.362, H59.363, H59.369, H90.A11, H90.A12, H90.A21, H90.A22, H90.A31, H90.A32, H93.A1, H93.A2, H93.A3, H93.A9, H95.51, H95.52, H95.53, H95.54 I60.2, I63.013, I63.033, I63.113, I63.133, I63.213, I63.233, I63.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433, I63.443, I63.513, I63.523, I63.533, I63.543, I72.5, I72.6, I77.75 and Q87.82 and deleted ICD-10 codes H34.811, H34.812, H34.813, H34.831, H34.832, H34.833, I60.21 and I60.22. Under ICD-10 Codes That Support Medical Necessity Group 2: Codes added ICD-10 code I77.77 and revised the code description for ICD-10 code I77.79. Under ICD-10 Codes That Support Medical Necessity Group 3: Codes added ICD-10 codes C49.A0, C49.A1, C49.A2, C49.A3, C49.A4, D49.511, D49.512, D49.519, D49.59, D78.31, D78.32, D78.33, D78.34, K55.011, K55.012, K55.019, K55.021, K55.022, K55.029, K55.031, K55.032, K55.039, K55.041, K55.042, K55.049, K55.051, K55.052, K55.059, K55.061, K55.062, K55.069, K55.30, K55.31, K55.32, K55.33, K85.01, K85.02, K85.81, K85.82, K85.91, K85.92, K91.870, K91.871, K91.872, K91.873, N99.840, N99.841, Q25.42, Q25.43, Q25.44, Q25.49, Q87.82, R93.41, R93.421, R93.422, R93.429 and R93.49. Under ICD-10 Codes That Support Medical Necessity Group 4: Codes added ICD-10 codes J95.860, J95.861, J95.862, J95.863, Q25.21, Q25.29, Q25.40, Q25.41, Q25.42, Q25.43, Q25.44, Q25.45, Q25.46, Q25.47, Q25.48, Q25.49 and Q87.82. Under ICD-10 Codes That Support Medical Necessity Group 5: Codes added ICD-10 codes C49.A5, N99.840 and N99.841. This revision is due to the Annual ICD-10 Code Update and becomes effective 10/01/16.
  • Provider Education/Guidance
  • Revisions Due To ICD-10-CM Code Changes
01/22/2016 R3 Under CMS National Coverage Policy in the reference to CMS Internet-Only Manual Pub 100-03, Chapter 1, Part 4 removed “220.3” and “(replaced with section 220.2)”and under CMS Internet-Only Manual Pub 100-04, Chapter 13 removed “40 Magnetic Resonance Imaging (MRI) Procedures” as these references are not valid to the MRA policy.
Under Associated Information corrected grammar and removed “for services on or after July 7, 2011”.
Under Sources of Information and Basis for Decision updated the reference for American College of Radiology- Blunt Chest Trauma-Suspected Aortic Injury-ACR Appropriateness Criteria to show 2014 (latest version).
  • Provider Education/Guidance
  • Public Education/Guidance
  • Other (Annual Validation)
10/01/2015 R2 Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.
  • Other (Bill type and/or revenue code removal)
10/01/2015 R1 Under Coverage Indications, Limitations and/or Medical Necessity changed Manual system to Internet-Only Manual in the first sentence. Added the verbiage MRA is considered appropriate when it can replace a more invasive test (e.g., contrast angiography) and reduce risk for beneficiaries. In addition, the services must be reasonable and necessary for the diagnosis or treatment of the specific patient involved.

Under Bill Type Codes,, added 023x Skilled Nursing Outpatient.

Under Sources of Information and Basis for Decision added individual citations for the American College of Radiology ACR Appropriateness Criteria for Blunt Chest trauma-Suspected Aortic injury; Blunt Chest Trauma; Sudden Onset of Cold, painful Leg; Follow up of lower extremity Arterial Bypass Surgery; Cerebrovascular Disease; and recurrent Symptoms following Lower Extremity Angioplasty.
  • Provider Education/Guidance
  • Other (Annual Validation)
N/A

Associated Documents

Attachments
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Related National Coverage Documents
NCDs
220.2 - Magnetic Resonance Imaging
Public Versions
Updated On Effective Dates Status
12/06/2024 01/26/2025 - N/A Future Effective You are here
10/14/2019 10/24/2019 - 01/25/2025 Currently in Effect View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • MRA
  • Magnetic Resonance Angiography

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