Does S8037 require prior authorization?

Yes, S8037 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S8037?

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

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`S8037`, Magnetic resonance cholangiopancreatography (mrcp)

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documented clinical indication for MRCP (e.g., symptoms such as obstructive jaundice, cholangitis, biliary-type abdominal pain, pancreatitis).
Pre-test probability and relevant clinical context (e.g., suspected choledocholithiasis, cholestatic liver enzyme pattern, prior imaging findings).

Key Coverage Criteria

Medically necessary MRI or CT imaging in hospital outpatient department when: (1) in clinical trial with specific imaging protocol/equipment not available freestanding facility; (2) scheduled within 24 hours of hospital specialist appointment at same hospital-based facility; (3) known allergy to contrast agent; (4) chronic disease under active treatment requiring same protocol/equipment for prior comparisons at same hospital facility; (5) systemic cancer on active treatment with restaging requir [...]
Adjunctive imaging in suspected autoimmune pancreatitis (AIP) to evaluate main pancreatic duct narrowing, MPD integrity (secretin-MRCP may demonstrate duct-penetrating sign), and parenchymal features (but MRCP cannot fully replace ERCP in AIP diagnostic workup).
Imaging of biliary tree to help plan directed interventions (endoscopic or transhepatic) in complex biliary disease where MRCP may increase likelihood of success and decrease risk.
Preoperative evaluation of the common bile duct prior to laparoscopic cholecystectomy in persons with elevations of their transaminases or common bile duct dilatation on abdominal imaging (ultrasound or CT scan).
Non-invasive imaging to demonstrate biliary calculi and pancreatic ductal disease (general role of MRCP in biliary/pancreatic evaluation).
Diagnosis of choledocholithiasis/common bile duct (CBD) stones in patients suspected of having CBD stones (used as a first-line or noninvasive diagnostic test in appropriate clinical settings).

14 Active Policies

EVICORE-HPLAN-AETNA-5BB4F6E94100, Aetna Cardiology and Radiology Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-3623642AC89E, Cigna Commercial Radiology Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-8D36BD1DD145, Cigna OBM Radiology Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-B17FDA871CCE, Cigna Commercial & Medicare Cardiology & Radiology Code List - Effective 01/01/2026

EVICORE-HPLAN-EMBLEM_GHI-47D7797307C9, GHI/Emblem Non-City of New York & Medicare Radiology and Cardiology Code List - Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-CFF312B0BB7B, Health Partners Plans Cardiology, Radiology, and Ultrasound Code List – Effective 07/01/2025

CARELON-imaging-of-the-abdomen-and-pelvis-2025-03-23, Imaging of the Abdomen and Pelvis

CARELON-imaging-of-the-abdomen-and-pelvis-2026-04-04, Imaging of the Abdomen and Pelvis

CARELON-oncologic-imaging-2025-11-15, Oncologic Imaging

CARELON-oncologic-imaging-2026-04-04, Oncologic Imaging

UHC-POL-mri-ct-scan-site-of-service, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service

AETNA-CPB-0384, Magnetic Resonance Cholangiopancreatography

UMR-POL-UMR-mri-ct-scan-site-of-service, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service

`S8037`, Magnetic resonance cholangiopancreatography (mrcp)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

S8037, Magnetic resonance cholangiopancreatography (mrcp)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

`S8037`, Magnetic resonance cholangiopancreatography (mrcp)