CPT - 72125 - 72158, 72148, 72158 - MRI and CT Scans of the Spine

Procedure code and description


72148 - MRI lumbar spine w/o dye - average fee payment - $230 - $240

72141 - Mri neck spine w/o dye  - average fee payment - $230 - $240

72156 Syringomyelia (Syrinx) Myelopthy Discitis (disk infection) Multiple Sclerosis (MS) Osteomyelitis


MRI SPINE Lumbar

MRI Lumbar Spine without contrast 72148 Back/leg pain Sciatica/radiculopathy Degenerative disk disease Spondylolisthesis Disk herniation (HNP) Spinal stenosis Radiculopathy Compression fracture Trauma Scoliosis No  Neurology

MRI Lumbar Spine with and without contrast 72158 Discitis (disk infection) Post-op hx of back surgery Osteomyelitis Tumor/Mass/Cancer/Mets Yes Neurology



Indications and Limitations of Coverage and/or Medical Necessity

    Magnetic Resonance Imaging (MRI) is used to diagnose a variety of central nervous system disorders. Unlike computed tomography (CT) scanning, MRI does not make use of ionizing radiation or require iodinated contrast material (known for causing hypersensitivity reactions and nephrotoxicity in susceptible patients) to distinguish normal from pathologic tissue. Rather, the difference in the number of protons contained within hydrogen-rich molecules in the body (water, proteins, lipids, and other macromolecules) determines recorded image qualities and makes possible the distinction of spinal cord from intra- vertebral disc, tumor from normal tissue, and flowing blood within vascular structures.

    MRI is able to image in multiple planes, a distinct advantage in the diagnosis of spinal cord and vertebral column anomalies. MRI is also superior to myelography, a riskier, more uncomfortable, and less informative procedure than MRI.
The choice of the appropriate imaging modality or combination of imaging modalities should be determined at an individual level, without dependence upon protocols, which may disregard such individual presentations. In some cases, Magnetic Resonance Imaging (MRI) may be an appropriate initial choice; in others, it may be advisable to use other techniques such as ultrasound, standard X-ray or CT scans.

General Imaging Indications
  • Evaluation of the spine in patients with infections of the brain, spinal column or contiguous areas or those having systemic infection.
  • Detection and characterization of neoplastic processes that may affect the spine, either primary or secondary.
  • Characterization of endocrine or other systemic diseases that may affect the spine.
  • Assessing injury or spinal sequelae after trauma or surgery. In individuals with certain systemic diseases, the trauma need not be major to cause injury. Minor trauma (e.g., nursing home falls) often does not result in cervical spine fractures or other significant injury. Imaging may be unnecessary when reliable historical information regarding the traumatic event/injury and physical examination (e.g. patients who are fully/awake and alert, no sensory deficit, no distracting pain, etc.) have ruled out significant cervical spine injury. Imaging is generally appropriate in the absence of reliable history and/or physical information, or when examination cannot exclude the possibility of significant injury of the spine or spinal contents.
  • For assessment of prolonged pain, pain with neurological manifestations or with an unusual presentation of pain.
  • For assessing certain arthritides with spine manifestations.
  • For assessing certain neurologic disorders.
  • For assessing congenital disorders that may affect the spine.
  • For further characterizing an abnormality detected on another imaging exam.
Screening
This Medicare contractor’s utilization data underlines TrailBlazer’s concern regarding imaging for screening purposes. While a symptom such as back pain may be a justifiable reason for ordering an imaging procedure, a high rate of usage of codes such as this, unsupported by general clinical evidence of medical necessity, will be regarded as screening and will invite review.
When multiple imaging modalities are performed for the same clinical condition, coverage of MRI may be denied if it is determined the MRI was not reasonable and necessary in addition to the previous diagnostic studies. Concurrent ordering of MRI and CT imaging would also suggest screening as the reason for the studies and invite medical review.
The clinical necessity for performing one or other imaging modality must be inferred from the medical record. The contractor acknowledges that both types of scans may be necessary in certain circumstances, but will be alert to unnecessary or "screening" imaging or duplication of imaging. The medical record should state the reasons for employing both imaging modalities.
Generally, MRI should be used when the following disorders are present or suspected:
  • Intramedullary tumors of spinal cord.
  • Suspected spinal infections.
  • Syringomyelia/syringohydromyelia.
  • Cord infarction.
  • Vertebral fractures.
  • Radiation myelitis.
  • Postoperative spine evaluation.
  • Developmental abnormalities.
  • Spinal cord compression.
  • Radiculopathy.
  • Demyelination or inflammation.
  • Metastatic/neoplastic disease of the spine.
  • Discitis and vertebral osteomyelitis.
  • Spinal cord trauma.
  • Spinal stenosis (CT may occasionally be preferred to MRI for evaluating spinal stenosis).
Generally, CT scanning should be used when the following disorders/situations are present or suspected:
  • Fractures.
  • Arthritis.
  • Bone neoplasms.
  • When performed in conjunction with contrast myelography.
MRI may be necessary for the conditions when CT is the preferred modality if there are unusual circumstances, or when better characterization or presentation of the associated soft tissue elements is necessary for the diagnosis or treatment.
CT may be necessary for the conditions when MRI is the preferred modality if there are unusual circumstances or when better characterization or presentation of the associated bony elements is necessary for diagnosis or treatment. CT is an integral part of contrast myelography under all circumstances.
The choice of modality should be determined at an individual level, based on the patient’s condition.
Magnetic Resonance Imaging
Diagnostic examinations of the spine performed on MRI units are covered if they are:
  • Reasonable and medically necessary for the individual patient.
  • Performed on a unit that has received federal Food and Drug Administration (FDA) approval. Such a unit(s) must be operated within the parameters specified by that approval.
The use of MRI has advantages over X-rays due to the absence of ionizing radiation and the ability of MRI to achieve high levels of tissue contrast resolution without injection of iodinated contrast agents. Paramagnetic contrast agents are available for better visualization in selected situations. Avoiding contrast injection may be especially important in patients with renal failure, prior serious reaction to iodinated contrast material and patients at risk of complication from fluid volume overload. MRI may become a more optimal imaging modality in these cases.
Ferromagnetic contrast-enhanced images are useful in evaluation of primary and metastatic neoplasms, infection, inflammation, demyelination and post-operative scarring and recurrent and/or residual disc herniation.
There are relative contraindications to MRI scanning. These include cardiac pacemakers, ferromagnetic clips, intraocular metal and cochlear implants. MRI scanning under these circumstances is only covered when the medical situation is clearly explained.
Note: This LCD addresses standard MR imaging. Magnetic Resonance Angiography (MRA) is not addressed in this LCD.
CT Scanning
Diagnostic examinations of the spine performed by computerized tomography scanners are covered if they are:
  • Reasonable and medically necessary for the individual patient.
  • Performed on a model of CT equipment that meets specific Medicare criteria.
Please note that the above lists may not include all the indications for MRI or CT, but are offered to indicate the “preferred” choice.
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

 Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.

Contraindications:

    The MRI is not covered when the following patient-specific contraindications are present:

    • MRI is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms unless the Medicare beneficiary meets the provisions of the following exceptions:

    Effective for claims with dates of service on or after July 7, 2011, the contraindications will not apply to pacemakers when used according to the FDA-approved labeling in an MRI environment, or effective for claims with dates of service on or after February 24, 2011, CMS believes that the evidence is promising although not yet convincing that MRI will improve patient health outcomes if certain safeguards are in place to ensure that the exposure of the device to an MRI environment adversely affects neither the interpretation of the MRI result nor the proper functioning of the implanted device itself. We believe that specific precautions (as listed below) could maximize benefits of MRI exposure for beneficiaries enrolled in clinical trials designed to assess the utility and safety of MRI exposure. Therefore, CMS determines that MRI will be covered by Medicare when provided in a clinical study under section 1862(a)(1)(E) (consistent with section 1142 of the Act) through the Coverage with Study Participation (CSP) form of Coverage with Evidence Development (CED) if the study meets the criteria in each of the three paragraphs in CMS Pub 100-03, CMS National Coverage Determination Manual, Chapter 1, Section 220.2.C.1.

    • MRI during a viable pregnancy is also contraindicated at this time.

    • The danger inherent in bringing ferromagnetic materials within range of MRI units generally constrains the use of MRI on acutely ill patients requiring life support systems and monitoring devices that employ ferromagnetic materials.

    • In addition, the long imaging time and the enclosed position of the patient may result in claustrophobia, making patients who have a history of claustrophobia unsuitable candidates for MRI procedures.

    Nationally Non-Covered Indications:


    CMS has determined that MRI of cortical bone and calcifications, and procedures involving spatial resolution of bone and calcifications, are not considered reasonable and necessary indications within the meaning of section 1862(a)(1)(A) of the Act, and are therefore non-covered.

Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 18X, 21X, 22X, 23X, 71X, 75X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
72125©
Ct neck spine w/o dye
72126©
Ct neck spine w/dye
72127©
Ct neck spine w/o&w dye
72128©
Ct chest spine w/o dye
72129©
Ct chest spine w/dye
72130©
Ct chest spine w/o&w dye
72131©
Ct lumbar spine w/o dye
72132©
Ct lumbar spine w/dye
72133©
Ct lumbar spine w/o&w dye
72141©
Mri neck spine w/o dye
72142©
Mri neck spine w/dye
72146©
Mri chest spine w/o dye
72147©
Mri chest spine w/dye
72148©
Mri lumbar spine w/o dye
72149©
Mri lumbar spine w/dye
72156©
Mri neck spine w/o&w dye
72157©
Mri chest spine w/o&w dye
72158©
Mri lumbar spine w/o&w dye
76380©
Cat scan follow-up study
Numerator Statement:

Number of Lumbar MRI studies where there are indications in the claim file of antecedent conservative therapy among patients with low back pain (excluding operative, tumor, and acute injury cases). Antecedent conservative therapy may include codes for injectable analgesic care, manual therapy or massage, chiropractic care, or a prior exam for low back pain evaluation.

72148 – MRI Lumbar Spine without Contrast;
72149 – MRI Lumbar Spine with Contrast;
72158 – MRI Lumbar Spine With and Without Contrast


ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
List A
Medicare is establishing the following limited coverage for CPT/HCPCS codes 72125, 72126, 72127, 72141, 72142 and 72156 (CT and MRI of cervical spine):
Covered for:
003.21
Salmonella meningitis
013.00–013.06
Tuberculous meningitis
013.10–013.16
Tuberculoma of meninges
013.20–013.26
Tuberculoma of brain
013.30–013.36
Tuberculous abscess of brain
013.40–013.46
Tuberculoma of spinal cord
013.50–013.56
Tuberculous abscess of spinal cord
013.60–013.66
Tuberculous encephalitis or myelitis
015.00–015.06
Tuberculosis of vertebral column
045.00–045.03
Acute paralytic poliomyelitis specified as bulbar
045.10–045.13
Acute poliomyelitis with other paralysis
045.20–045.23
Acute non-paralytic poliomyelitis
045.90–045.93
Acute poliomyelitis, unspecified
091.81
Acute syphilitic meningitis (secondary)
094.0–094.3
Neurosyphilis
094.81–094.87
Other specified neurosyphilis
094.89
Other specified neurosyphilis, other
094.9
Neurosyphilis, unspecified
098.82
Gonococcal meningitis
100.81
Leptospiral meningitis (aseptic)
112.83
Candidal meningitis
114.2
Coccidioidal meningitis
115.01
Histoplasma capsulatum meningitis
115.11
Histoplasma duboisii meningitis
130.0
Meningoencephalitis due to toxoplasmosis
140.0–140.1
Malignant neoplasm of lip
140.3–140.6
Malignant neoplasm of lip
140.8–140.9
Malignant neoplasm of lip
141.0–141.6
Malignant neoplasm of tongue
141.8–141.9
Malignant neoplasm of tongue
142.0142.2
Malignant neoplasm of major salivary glands
142.8142.9
Malignant neoplasm of major salivary glands
143.0143.1
Malignant neoplasm of gum
143.8143.9
Malignant neoplasm of gum
144.0–144.1
Malignant neoplasm of floor of mouth
144.8–144.9
Malignant neoplasm of floor of mouth
145.0–145.6
Malignant neoplasm of other and unspecified parts of mouth
145.8–145.9
Malignant neoplasm of other and unspecified parts of mouth
146.0–146.9
Malignant neoplasm of oropharynx
147.0–147.3
Malignant neoplasm of nasopharynx
147.8–147.9
Malignant neoplasm of nasopharynx
148.0–148.3
Malignant neoplasm of hypopharynx
148.8–148.9
Malignant neoplasm of hypopharynx
149.0–149.1
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
149.8–149.9
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
150.0–150.5
Malignant neoplasm of esophagus
150.8150.9
Malignant neoplasm of esophagus
151.0151.6
Malignant neoplasm of stomach
151.8151.9
Malignant neoplasm of stomach
152.0152.3
Malignant neoplasm of small intestine, including duodenum
152.8152.9
Malignant neoplasm of small intestine, including duodenum
153.0153.9
Malignant neoplasm of colon
154.0–154.3
Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.8
Malignant neoplasm of anus unspecified
155.0–155.2
Malignant neoplasm of liver and intrahepatic bile ducts
156.0–156.2
Malignant neoplasm of gallbladder and extrahepatic bile ducts
156.8–156.9
Malignant neoplasm of gallbladder and extrahepatic bile ducts
157.0–157.4
Malignant neoplasm of pancreas
157.8–157.9
Malignant neoplasm of pancreas
158.0
Malignant neoplasm of retroperitoneum
158.8
Malignant neoplasm of specified parts of peritoneum
159.0–159.1
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
159.8–159.9
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
160.0–160.5
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
160.8–160.9
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
161.0–161.3
Malignant neoplasm of larynx
161.8–161.9
Malignant neoplasm of larynx
162.0
Malignant neoplasm of trachea
162.2–162.5
Malignant neoplasm of trachea, bronchus, and lung
162.8–162.9
Malignant neoplasm of trachea, bronchus, and lung
163.0–163.1
Malignant neoplasm of pleura
163.8–163.9
Malignant neoplasm of pleura
164.0–164.3
Malignant neoplasm of thymus, heart, and mediastinum
164.8–164.9
Malignant neoplasm of thymus, heart, and mediastinum
165.0
Malignant neoplasm of upper respiratory tract, part unspecified
165.8–165.9
Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs
170.0–170.9
Malignant neoplasm of bone and articular cartilage
171.0
Malignant neoplasm of connective and other soft tissue, head, face and neck
171.2–171.9
Malignant neoplasm of connective and other soft tissue
172.0–172.9
Malignant melanoma of skin
173.0–173.9
Other malignant neoplasm of skin
174.0–174.6
Malignant neoplasm of female breast
174.8–174.9
Malignant neoplasm of female breast
175.0
Malignant neoplasm of male breast, nipple and areola
175.9
Malignant neoplasm of other and unspecified sites of male breast
176.0–176.5
Kaposi’s sarcoma
176.8–176.9
Kaposi’s sarcoma
179
Malignant neoplasm of uterus, part unspecified
180.0–180.1
Malignant neoplasm of cervix uteri
180.8–180.9
Malignant neoplasm of cervix uteri
181
Malignant neoplasm of placenta
182.0–182.1
Malignant neoplasm of body of uterus
182.8
Malignant neoplasm of other specified site of body of uterus
183.0
Malignant neoplasm of ovary
183.2–183.5
Malignant neoplasm of ovary and other uterine adnexa
183.8–183.9
Malignant neoplasm of ovary and other uterine adnexa
184.0–184.4
Malignant neoplasm of other and unspecified female genital organs
184.8–184.9
Malignant neoplasm of other and unspecified female genital organs
185
Malignant neoplasm of prostate
186.0
Malignant neoplasm of undescended testis
186.9
Malignant neoplasm of other and unspecified testis
187.1–187.9
Malignant neoplasm of penis and other male genital organs
188.0–188.9
Malignant neoplasm of bladder
189.0–189.4
Malignant neoplasm of kidney and other and unspecified urinary organs
189.8–189.9
Malignant neoplasm of kidney and other and unspecified urinary organs
190.0–190.9
Malignant neoplasm of eye
192.1–192.3
Malignant neoplasm of cerebral meninges, spinal cord, and spinal meninges
193
Malignant neoplasm of thyroid gland
194.6
Malignant neoplasm of aortic body and other paraganglia
195.0–195.5
Malignant neoplasm of other and ill-defined sites
195.8
Malignant neoplasm of other specified sites
196.0–196.3
Secondary and unspecified malignant neoplasm of lymph nodes
196.5–196.6
Secondary and unspecified malignant neoplasm of lymph nodes
196.8–196.9
Secondary and unspecified malignant neoplasm of lymph nodes
197.0–197.8
Secondary malignant neoplasm of respiratory and digestive systems
198.0*–198.7*
Secondary malignant neoplasm of other specified sites
198.81*–198.82*
Secondary malignant neoplasm of other specified sites
198.89*
Secondary malignant neoplasm of other specified sites
Note: Use 198.XX range of codes to indicate metastases to the spinal column.
199.0–199.2
Malignant neoplasm without specification of site
200.00–200.08
Reticulosarcoma
200.10–200.18
Lymphosarcoma
200.20–200.28
Burkitt’s tumor or lymphoma
200.30–200.38
Marginal zone lymphoma
200.40–200.48
Mantle cell lymphoma
200.50–200.58
Primary central nervous system lymphoma
200.60–200.68
Anaplastic large cell lymphoma
200.70–200.78
Large cell lymphoma
200.80–200.88
Lymphosarcoma and reticulosarcoma, other named variants
201.00–201.08
Hodgkin’s paragranuloma
201.10–201.18
Hodgkin’s granuloma
201.20–201.28
Hodgkin’s sarcoma
201.40–201.48
Hodgkin’s disease, lymphocytic-histiocytic predominance
201.50–201.58
Hodgkin’s disease, nodular sclerosis
201.60–201.68
Hodgkin’s disease, mixed cellularity
201.70–201.78
Hodgkin’s disease, lymphocytic depletion
201.90–201.98
Hodgkin’s disease, unspecified
202.00–202.08
Nodular lymphoma
202.10–202.18
Mycosis fungoides
202.20–202.28
Sezary’s disease
202.30–202.38
Malignant histiocytosis
202.40–202.48
Leukemic reticuloendotheliosis
202.50–202.58
Letterer-Siwe disease
202.60–202.68
Malignant mast cell tumors
202.70–202.78
Peripheral T cell lymphoma
202.80–202.88
Other lymphomas
202.90–202.98
Other and unspecified malignant neoplasms of lymphoid and histocytic tissue
203.00–203.02
Multiple myeloma
203.10–203.12
Plasma cell leukemia
203.80–203.82
Other immunoproliferative neoplasms
204.00–204.02
Acute lymphoid leukemia
204.10–204.12
Chronic lymphoid leukemia
204.20–204.22
Subacute lymphoid leukemia
204.80–204.82
Other lymphoid leukemia
204.90–204.92
Unspecified lymphoid leukemia
205.00–205.02
Acute myeloid leukemia
205.10–205.12
Chronic myeloid leukemia
205.20–205.22
Subacute myeloid leukemia
205.30–205.32
Myeloid sarcoma
205.80–205.82
Other myeloid leukemia
205.90–205.92
Unspecified myeloid leukemia
206.00–206.02
Acute monocytic leukemia
206.10–206.12
Chronic monocytic leukemia
206.20–206.22
Subacute monocytic leukemia
206.80–206.82
Other monocytic leukemia
206.90–206.92
Unspecified monocytic leukemia
207.00–207.02
Acute erythremia and erythroleukemia
207.10–207.12
Chronic erythremia
207.20–207.22
Megakaryocytic leukemia
207.80–207.82
Other specified leukemia
208.00–208.02
Acute leukemia of unspecified cell type
208.10–208.12
Chronic leukemia of unspecified cell type
208.20–208.22
Subacute leukemia of unspecified cell type
208.80–208.82
Other leukemia of unspecified cell type
208.90–208.92
Unspecified leukemia of unspecified cell type
213.2
Benign neoplasm of vertebral column, excluding sacrum and coccyx
213.9
Benign neoplasm of bone and articular cartilage, site unspecified
215.8–215.9
Other benign neoplasm of connective and other soft tissue
225.3–225.4
Benign neoplasm of brain and other parts of nervous system
225.8–225.9
Benign neoplasm of brain and other parts of nervous system
227.6
Benign neoplasm of aortic body and other paraganglia
228.00
Hemangioma of unspecified site
228.09
Hemangioma of other sites
237.5–237.6
Neoplasm of uncertain behavior of endocrine glands and nervous system
237.70–237.73
Neurofibromatosis
237.79
Other neurofibromatosis
237.9
Neoplasm of uncertain behavior of other and unspecified parts of nervous system
238.0–238.1
Neoplasm of uncertain behavior of other and unspecified sites and tissues
238.6
Neoplasm of uncertain behavior of plasma cells
238.72–238.75
Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues
239.2
Neoplasm of unspecified nature of bone, soft tissue, and skin
239.6–239.7
Neoplasm of unspecified nature
239.89
Neoplasms of unspecified nature, other specified sites
320.0–320.3
Bacterial meningitis
320.7
Meningitis in other bacterial diseases classified elsewhere
320.81
Meningitis due to other specified bacteria
320.89
Meningitis due to other specified bacteria
320.9
Meningitis due to unspecified bacterium
321.0–321.4
Meningitis due to other organisms
321.8
Meningitis due to other non-bacterial organisms classified elsewhere
322.0–322.2
Meningitis of unspecified cause
322.9
Meningitis, unspecified
323.01–323.02
Encephalitis, myelitis, and encephalomyelitis in viral diseases, classified elsewhere
323.1–323.2
Encephalitis, myelitis, and encephalomyelitis
323.41–323.42
Other encephalitis, myelitis, and encephalomyelitis due to infection, classified elsewhere
323.52
Myelitis following immunization procedures
323.61–323.63
Postinfectious encephalitis, myelitis, and encephalomyelitis
323.71–323.72
Toxic encephalitis and encephalomyelitis – Toxic myelitis
323.81–323.82
Other causes of encephalitis, myelitis, and encephalomyelitis
323.9
Unspecified cause of encephalitis
324.1
Intraspinal abscess
326
Late effects of intracranial abscess or pyogenic infection
335.20–335.24
Motor neuron disease
335.29
Other motor neuron diseases
336.0–336.3
Other diseases of spinal cord
336.8–336.9
Other diseases of spinal cord
340
Multiple sclerosis
341.0–341.1
Other demyelinating diseases of central nervous system
341.8–341.9
Other demyelinating diseases of central nervous system
343.0–343.4
Infantile cerebral palsy
343.8–343.9
Infantile cerebral palsy
344.00–344.04
Other paralytic syndromes
344.09
Other quadriplegia
344.1–344.2
Other paralytic syndromes
344.89
Other specified paralytic syndrome
349.1–349.2
Other and unspecified disorders of the nervous system
349.31
Accidental puncture or laceration of dura during a procedure
349.39
Other dural tear
353.2
Cervical root lesions, not elsewhere classified
354.4
Causalgia of upper limb
442.89*
Aneurysm of other specified site
Note: Use 442.89 to indicate aneurysm of spinal artery.
714.0
Rheumatoid arthritis
714.30
Chronic or unspecified polyarticular juvenile rheumatoid arthritis
720.0
Ankylosing spondylitis
720.81
Inflammatory spondylopathies in diseases classified elsewhere
721.1
Cervical spondylosis with myelopathy
721.91
Spondylosis of unspecified site with myelopathy
722.0
Displacement of cervical intervertebral disc without myelopathy
722.2
Displacement of intervertebral disc, site unspecified, without myelopathy
722.4
Degeneration of cervical intervertebral disc
722.71
Intervertebral disc disorder with myelopathy, cervical region
722.81
Postlaminectomy syndrome of cervical region
722.91
Other and unspecified disc disorder of cervical region
723.0
Spinal stenosis in cervical region
723.4
Brachial neuritis or radiculitis NOS
724.00
Spinal stenosis of unspecified region
730.08
Acute osteomyelitis involving other specified sites
730.18
Chronic osteomyelitis involving other specified sites
732.0
Juvenile osteochondrosis of spine
733.00–733.03
Other disorders of bone and cartilage, osteoporosis
733.09
Other disorders of bone and cartilage
733.10–733.16
Other disorders of bone and cartilage, pathologic fracture
733.19
Pathologic fracture of other specified site
733.20–733.22
Other disorders of bone and cartilage, cyst of bone
733.29
Other bone cyst
733.3
Hyperostosis of skull
733.40–733.44
Other disorders of bone and cartilage, aseptic necrosis of bone
733.49
Aseptic necrosis of other bone sites
733.5–733.7
Other disorders of bone and cartilage
733.81–733.82
Malunion and non-union of fracture
733.90–733.92
Disorder of bone and cartilage, unspecified
733.99
Other disorders of bone and cartilage, other
737.0
Adolescent postural kyphosis
737.10–737.12
Curvature of spine, kyphosis (acquired)
737.19
Other kyphosis, (acquired) (postural)
737.20–737.22
Curvature of spine, lordosis (acquired)
737.29
Other lordosis, acquired
737.30–737.34
Curvature of spine, kyphoscoliosis and scoliosis
737.39
Other kyphoscoliosis and scoliosis
737.40–737.43
Curvature of spine associated with other conditions
737.8*–737.9*
Curvature of spine
Note: Use 737.8 or 737.9 to indicate patients with clinically significant symptoms or for preoperative evaluation.
738.4
Acquired spondylolisthesis
741.00–741.01
Spina bifida, with hydrocephalus
741.90–741.91
Spina bifida, without mention of hydrocephalus
742.51
Diastematomyelia
742.53
Hydromyelia
742.59
Other specified congenital anomalies of spinal cord
742.9
Unspecified congenital anomaly of brain, spinal cord, and nervous system
747.82
Spinal vessel anomaly
754.2
Congenital musculoskeletal deformities of spine
756.12
Spondylolisthesis, congenital
756.4
Chondrodystrophy
758.0
Down’s syndrome
767.4
Injury to spine and spinal cord due to birth trauma
781.2
Abnormality of gait
781.4
Transient paralysis of limb
782.0
Symptom, disturbance of skin sensation
793.7*
Non-specific (abnormal) findings on radiological and other examination of musculoskeletal system
Note: Use 793.7 to indicate an abnormal bone scan.
793.91
Image test inconclusive due to excess body fat
793.99
Other nonspecific (abnormal) findings on radiological and other examination of body structure
805.00–805.08
Fracture of vertebral column without mention of spinal cord injury, cervical, closed
805.10–805.18
Fracture of vertebral column without mention of spinal cord injury, cervical, open
805.8–805.9
Fracture of vertebral column without mention of spinal cord injury
806.00–806.09
Fracture of vertebral column with spinal cord injury, cervical, closed
806.10–806.19
Fracture of vertebral column with spinal cord injury, cervical, open
806.8–806.9
Fracture of vertebral column with spinal cord injury
839.00–839.08
Other, multiple, and ill-defined dislocations, cervical vertebra, closed
839.10–839.18
Other, multiple, and ill-defined dislocations, cervical vertebra, open
839.49
Closed dislocation, other vertebra, other
839.59
Open dislocation, other vertebra, other
847.0
Neck Sprain
909.2
Late effect of radiation
925.2
Crushing injury of neck
926.11
Crushing injury of back
952.00–952.09
Spinal cord injury without evidence of spinal bone injury, cervical
952.8–952.9
Spinal cord injury without evidence of spinal bone injury
953.0
Injury to cervical nerve root
959.01*
Head injury, unspecified
Note: Use 959.01 to indicate possible injury, in tandem with supporting notes in chart.
959.09*
Injury of face and neck
Note: Use 959.09 to indicate possible injury, in tandem with supporting notes in chart.
List B
Medicare is establishing the following limited coverage for CPT/HCPCS codes 72128, 72129, 72130, 72146, 72147 and 72157 (CT and MRI of thoracic spine):

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