MRI Pre-Authorization Guide
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MRI/MRA Categories:
Head/Brain
Cervical Spine
Thoracic Spine
Lumbosacral Spine
Orbits, Face or Neck
Tempomandibular Joints (TMJ)
Abdomen
Lower Extremity Joint (Hip, Knee, Ankle)
Lower Extremity Non Joint (Femur, Lower Leg, Foot)
Upper Extremity Joint (Shoulder, Elbow, Wrist)
Upper Extremity Non Joint (Humerus, Forearm, Hand)
Chest
Pelvis/SI Joints
Breast
MRA/MRV
Other Misc Codes
Helpful Links
MRI Health History Screening Form
Outpatient MRI Order Form
Breast MRI Order Form
Prep Reference Guide