Positional magnetic resonance imaging (MRI) allows imaging of individuals in various positions, including sitting and standing, and is being evaluated for the diagnosis of individuals with position-dependent back pain. Determining the cause of back pain is a complex task and positional MRI is purported to provide a more accurate diagnosis since images may be taken while the individual is partial or full weight bearing.
Positional (non-recumbent) magnetic resonance imaging (MRI) is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
The evidence is currently insufficient to evaluate whether the use of positional MRI improves health or treatment outcomes. Studies that correlate positional MRI findings with symptoms and outcomes of treatment are needed. Guidelines for interpreting positional MRI results have not been established due to the lack of data.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2017). Positional magnetic resonance imaging (6.01.48). Retrieved March 23, 2018 from BlueWeb. (7 articles and/or guidelines reviewed)
Diefenbach, C., Lonner, B., Auerbach, J., Bharucha, N., & Dean, L. (2013). Is radiation-free diagnostic monitoring of adolescent idiopathic scoliosis feasible using upright positional magnetic resonance imaging? Spine, 38 (7), 576-580. Abstract retrieved June 6, 2016 from PubMed database.
Gilbert, J. W., Martin, J. C., Wheeler, G. R., Storey, B. B., Mick, G. E., Richardson, G. B., et al. (2011). Lumbar stenosis rates in symptomatic patients using weight-bearing and recumbent magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics, 34 (8), 557-561. (Level 4 evidence)
Hedberg, K., Alexander, L., Cooper, K., Hancock, E., Ross, J., and Smith, F. (2013, April) Low back pain: an assessment using positional MRI and MDT. Manipulative Therapy;18 (2):169-71. Abstract retrieved March 15, 2017 from PubMed database.
Tarantino, U., Fannucci, E., Iundusi, R., Celi, M., Altobelli, S., Gasbarra, E., et al. (2013). Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes. Journal of Orthopedics and Traumatology, 14, 15-22. (Level 4 evidence)
U.S. Food and Drug Administration. (2000, March). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K994287 (FONAR 360® Scanner). Retrieved March 15, 2017 from http://www.accessdata.fda.gov.
U.S. Food and Drug Administration. (2006, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061930. Retrieved October 8, 2010 from http://www.accessdata.fda.gov.
Winifred S. Hayes, Inc. Medical Technology Directory. (2014, September; last update search August 2017). Upright magnetic resonance imaging for diagnosis of spinal disorders. Retrieved March 23, 2018 from www.Hayesinc.com/subscribers (43 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 6/13/2009
MOST RECENT REVIEW DATE: 5/10/2018
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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