Cigna prior authorization for 0865T*: Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the brain during the same session
Code
0865T*
Description
Quantitative magnetic resonance image (MRI) analysis of the brain with
comparison to prior magnetic resonance (MR) study(ies), including
lesion identification, characterization, and quantification, with brain
volume(s) quantification and/or severity score, when performed, data
preparation and transmission, interpretation and report, obtained
without diagnostic MRI examination of the brain during the same session
Source
Master Precertification List
For Health Care Providers, Pg 14 Original policy
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