Multiple Imaging in Oncology
JH · Effective Oct 1, 2015
4 active Medicare policies list 72197, and 33 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
National · Effective Aug 6, 2026
JL · Effective Jan 1, 2025
33 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 72197 |
|---|---|---|
| Aetna Cardiology and Radiology Code List | Jan 1, 2026 | Prior auth required |
| Defecography | Sep 21, 2023 | Covered |
| Gastrointestinal Function: Selected Tests | Aug 30, 2023 | Covered |
| Kidney Stones: Selected Interventions | Jun 6, 2023 | Covered |
| Open Air, Low Field Strength, and Positional Magnetic Resonance Imaging (MRI) Units | Mar 21, 2023 | Covered |
| Prostate Biopsy | Sep 26, 2023 |
| Covered |
| Virtual Gastrointestinal Endoscopy | Jul 21, 2023 | Covered |
|---|
| Policy | Effective | Status of 72197 |
|---|---|---|
| Advanced Imaging for Vascular Indications | Sep 19, 2026 | Covered |
| Imaging of the Abdomen and Pelvis | Apr 4, 2026 | Covered |
| Imaging of the Abdomen and Pelvis [for Amerigroup Georgia Medicaid] | Mar 23, 2025 | Covered |
| Oncologic Imaging | Apr 4, 2026 | Covered |
| Oncologic Imaging [for Amerigroup Georgia Medicaid] | Nov 15, 2025 | Covered |
| Site of Care for Advanced Imaging | Nov 17, 2024 | Covered |
| Vascular Imaging [for Wellpoint Massachusetts] | Nov 15, 2025 | Covered |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Musculoskeletal Imaging Guidelines | Feb 3, 2026 | Covered with conditions |
| Musculoskeletal MSK Imaging Guidelines | Feb 15, 2019 | Covered with conditions |
| Oncology Imaging Guideline Addendum | Aug 1, 2021 | Covered with conditions |
| Pediatric Pelvis Imaging Guidelines | Feb 3, 2026 | Covered |
| Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines | Feb 3, 2026 | Covered with conditions |
| Peripheral Nerve Disorders (PND) Imaging Guidelines | Feb 1, 2024 | Covered with conditions |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Cigna Commercial Radiology Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Cigna Commercial & Medicare Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |
| Cigna OBM Radiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Gastrointestinal Disorders Diagnostic Procedures | Jun 1, 2026 | Covered |
| Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Gastrointestinal Disorders Diagnostic Procedures | Jun 1, 2026 | Covered |
| Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 72197 |
|---|---|---|
| GHI/Emblem Non-City of New York & Medicare Radiology and Cardiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| EOCCO Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Health Alliance Plan Radiology Code List | Aug 1, 2026 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| Health Partners Plans Cardiology, Radiology, and Ultrasound Code List | Jul 1, 2025 | Prior auth required |
| Policy | Effective | Status of 72197 |
|---|---|---|
| The Health Plan Cardiology & Radiology Code List | Jan 1, 2026 | Prior auth required |