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

eviCore healthcare. (2019, February). Head imaging policy. Functional MRI (f-MRI).  Retrieved July 16, 2019 from www.evicore.com.  (4 articles and/or guidelines reviewed)

Håberg, A., Kvistad, K.A., Unsgård, G., & Haraldseth, O. (2004). Preoperative blood oxygen level dependent functional magnetic resonance imaging in patients with primary brain tumors: clinical application and outcome. Neurosurgery, 54 (4), 902-914. Abstract retrieved July 17, 2019 from PubMed database.

Medina, L.S., Bernal, B., Dunoyer, C., Cervantes, L., Rodriguez, M., Pacheco, E., et al. (2005). Seizure disorders: functional MR imaging for diagnostic evaluation and surgical treatment – prospective study. Radiology, 236 (1), 247-253. Abstract retrieved July 17, 2019 from https://pubs.rsna.org/doi/pdf/10.1148/radiol.2361040690.

Petrella, J.R., Shah, L.M., Harris, K.M., Friedman, A.H., George, T.M., Sampson, J.H., et al. (2006). Preoperative functional MR imaging localization of language and motor areas: effect on therapeutic decision making in patients with potentially resectable brain tumors. Radiology, 240 (3), 793-802. Abstract retrieved July 17, 2019 from PubMed database.

ORIGINAL EFFECTIVE DATE: 4/13/2012

MOST RECENT REVIEW DATE:  8/8/2019         

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.

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