These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.
Providers must comply with the decision support requirements when ordering diagnostic imaging. Approved decision support solutions will utilize criteria to determine the appropriateness of any diagnostic imaging ordered for HealthPartners' members. Please see related content at right for a link to HealthPartners Administrative Policy, Diagnostic Imaging Provider Notification Program, for additional information.
A CT or MRI is generally covered to diagnose a medical condition. To receive in network benefits, it must be performed by an in network provider. This policy is addressing technology for diagnostic purposes only. When these exams, tests, or procedures are ordered for screening purposes, there may not be coverage available.
Indications that are covered
- A diagnostic CT or MRI scan (including a breast MRI) is eligible for coverage if the treating medical provider determines it to be necessary for planning treatment due to your symptoms or risk factors.
- Standing/weight bearing-positional MRIs are covered when clinical circumstances preclude use of standard or open MRI. Clinical circumstances include obesity so severe that a patient cannot fit a standard or open MRI, failure to tolerate a standard or open MRI due to pain when lying down or claustrophobia.
Note: You may contact HealthPartners Member Services at 952-883-5000 if you have questions about designated facilities or coverage issues.
Indications that are not covered
- A CT or MRI is generally not covered for screening purposes. For more detail, please refer to the preventive services, and investigational services policies.
- Imaging tests, exams or procedures that are considered experimental/investigative are not covered. Please see our investigational services policy for details.
- Screening exams, procedures or tests are not covered when rendered by unlicensed providers.
- Standing/weight bearing-positional MRIs are not covered, except as described above, because there is insufficient evidence to demonstrate that their imaging performance is equivalent or superior to other MRI technology.
- Dynamic MRIs are not covered because there is insufficient evidence to demonstrate that their imaging performance is equivalent or superior to other MRI technology.
CT stands for computed tomography, which is a type of imaging test.
CT Scan is an imaging test that combines the use of a rotating x-ray device with a digital computer. It allows us to view cross-sectional images, or "slices" of body organs, blood vessels, and bones.
Diagnostic testing refers to an exam, procedure or test that is done to discover why a member is having signs or symptoms of a condition. These tests can confirm a condition is actually present, or they can confirm that a certain condition does not exist. Diagnostic testing is not considered a screening test.
Screening refers to a procedure/test used to find an illness or problem in people with no signs or symptoms of that condition.
MRI stands for magnetic resonance imaging. A MRI uses radio waves and magnetic energy to allow us to view cross-sectional images, or "slices" of the body.
The standing/weight bearing-positional magnetic resonance imaging (MRI) system is an adaptation of MRI technology that offers weight-bearing imaging of patients in standing, seated, or lying positions.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.