BlueCross BlueShield of Tennessee Medical Policy Manual

Functional Magnetic Resonance Imaging

DESCRIPTION

Functional magnetic resonance imaging (fMRI) is a noninvasive method for the evaluation of brain activity by detecting associated changes in blood flow. Images are collected while specific activities are performed to assist in the pre-surgical localization of “eloquent” areas such as motor function and speech.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The evidence suggests that although bilateral activation patterns in fMRI cannot be conclusively interpreted, fMRI in patients who are to undergo neurosurgery for seizures or brain tumors may help to define eloquent areas, reduce surgical time, and alter treatment decisions.

SOURCES

Albers, G., Thijs, V., Wechsler, L., et al. (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Annals of Neurology, (60) 508-517.    

American College of Radiology. (2017). ACR-ASNR-SPR practice parameters for the performance of functional magnetic resonance imaging (fMRI) of the brain. Retrieved October 23, 2017 from www.acr.org.

Centers for Medicare & Medicaid Services. CMS.gov. (2011, July) National Coverage Determination (NCD) for magnetic resonance imaging (220.2). Retrieved March 8, 2016 fromhttps://www.cms.gov.

Latchaw R., Kucharczyk, J., Moseley, M. et al. (2005) Imaging of the Nervous System. Philadelphia, Elsevier Press, pp.1089-1100, 101-120 and 1225-1239.

ORIGINAL EFFECTIVE DATE:  4/13/2012

MOST RECENT REVIEW DATE:  12/14/2017

ID_EC

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.