Does Q9953 require prior authorization?

No, Q9953 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for Q9953?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`Q9953`, Injection, iron-based magnetic resonance contrast agent, per ml

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
The documentation must clearly support the ICD-10-CM code(s) reported on the claim.

Radiologists and ordering physicians must include sufficient clinical information in the MRI report to justify necessity; the MRI report or clinical record must document clinical findings and relevant prior treatment.

Key Coverage Criteria

Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
Lumbar MRI is covered to evaluate suspected spinal neoplasm or to differentiate recurrent tumor from scar or granulation tissue.
Lumbar MRI is covered to evaluate suspected infection of the spine, including osteomyelitis and spinal cord abnormalities associated with osteomyelitis.
Lumbar MRI is covered when imaging information is necessary to determine need for surgery or other aggressive therapy (e.g., work-up for metastatic cancer or preoperative planning).

3 Active Policies

NORIDIAN-JE-L34220, Lumbar MRI

NORIDIAN-JF-L34220, Lumbar MRI

A57206, Billing and Coding: Lumbar MRI

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Q9953, Injection, iron-based magnetic resonance contrast agent, per ml