How do you obtain approval for an MRI prostate for radiation planning?

If a patient has had a diagnostic MRI, can you obtain another planning MRI after fiducial marker and SpaceOAR placement?

2 Answers

Mednet Member

Radiation Oncology · Tennessee Oncology

Answered on

Approval of another MRI using diagnostic CPT codes (e.g. 72197) is unlikely. CPT 76498 (unlisted MRI procedure) is commonly used for radiation treatment-planning MRIs, such as for brain and prostate. As an example, see eviCore's Onc-1.5 policy on this.

Have users seen repeated denials of CPT 76498 (...

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Mednet Member

Radiation Oncology · Centerpoint health

Answered on

We try to get approval.

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