1. What the letter is for
Study
Choose the study
MRI jaw joint (TMJ) (70336)
MRI orbit, face and neck without contrast (70540)
MRI orbit, face and neck with contrast (70542)
MRI orbit, face and neck without and with contrast (70543)
MRI brain without contrast (70551)
MRI brain with contrast (70552)
MRI brain without and with contrast (70553)
Functional MRI brain (70554)
Functional MRI brain with neurofunctional testing (70555)
MRI chest without contrast (71550)
MRI chest with contrast (71551)
MRI chest without and with contrast (71552)
MRI cervical spine without contrast (72141)
MRI cervical spine with contrast (72142)
MRI thoracic spine without contrast (72146)
MRI thoracic spine with contrast (72147)
MRI lumbar spine without contrast (72148)
MRI lumbar spine with contrast (72149)
MRI cervical spine without and with contrast (72156)
MRI thoracic spine without and with contrast (72157)
MRI lumbar spine without and with contrast (72158)
MRI pelvis without contrast (72195)
MRI pelvis with contrast (72196)
MRI pelvis without and with contrast (72197)
MRI arm (non-joint) without contrast (73218)
MRI arm (non-joint) without and with contrast (73220)
MRI arm joint (shoulder, elbow or wrist) without contrast (73221)
MRI arm joint (shoulder, elbow or wrist) with contrast (73222)
MRI arm joint (shoulder, elbow or wrist) without and with contrast (73223)
MRI leg (non-joint) without contrast (73718)
MRI leg (non-joint) without and with contrast (73720)
MRI leg joint (hip, knee or ankle) without contrast (73721)
MRI leg joint (hip, knee or ankle) with contrast (73722)
MRI leg joint (hip, knee or ankle) without and with contrast (73723)
MRI abdomen without contrast (74181)
MRI abdomen without and with contrast (74183)
Fetal MRI, single or first fetus (74712)
Fetal MRI, each additional fetus (74713)
Cardiac MRI without contrast (75557)
Cardiac MRI with stress imaging, without contrast (75559)
Cardiac MRI without and with contrast (75561)
Cardiac MRI with stress imaging, without and with contrast (75563)
Cardiac MRI velocity flow mapping (75565)
MR spectroscopy (76390)
MR elastography (76391)
Unlisted MRI procedure (76498)
MRI breast, one side, without contrast (77046)
MRI breast, both sides, without contrast (77047)
MRI breast, one side, without and with contrast (77048)
MRI breast, both sides, without and with contrast (77049)
MRI bone marrow blood supply (77084)
CT head without contrast (70450)
CT head with contrast (70460)
CT head without and with contrast (70470)
CT temporal bones and ear without contrast (70480)
CT temporal bones and ear with contrast (70481)
CT temporal bones and ear without and with contrast (70482)
CT face and sinuses without contrast (70486)
CT face and sinuses with contrast (70487)
CT face and sinuses without and with contrast (70488)
CT neck soft tissue without contrast (70490)
CT neck soft tissue with contrast (70491)
CT neck soft tissue without and with contrast (70492)
CT chest without contrast (71250)
CT chest with contrast (71260)
CT chest without and with contrast (71270)
Low-dose CT chest for lung cancer screening (71271)
CT cervical spine without contrast (72125)
CT cervical spine with contrast (72126)
CT cervical spine without and with contrast (72127)
CT thoracic spine without contrast (72128)
CT thoracic spine with contrast (72129)
CT thoracic spine without and with contrast (72130)
CT lumbar spine without contrast (72131)
CT lumbar spine with contrast (72132)
CT lumbar spine without and with contrast (72133)
CT pelvis without contrast (72192)
CT pelvis with contrast (72193)
CT pelvis without and with contrast (72194)
CT arm without contrast (73200)
CT arm with contrast (73201)
CT arm without and with contrast (73202)
CT leg without contrast (73700)
CT leg with contrast (73701)
CT abdomen without contrast (74150)
CT abdomen with contrast (74160)
CT abdomen without and with contrast (74170)
CT abdomen and pelvis without contrast (74176)
CT abdomen and pelvis with contrast (74177)
CT abdomen and pelvis without and with contrast (74178)
CT colonography, diagnostic, without contrast (74261)
CT colonography, diagnostic, with contrast (74262)
CT colonography, screening (74263)
CT heart for coronary calcium scoring (75571)
CT heart structure with contrast (75572)
CT heart for congenital heart disease (75573)
CT limited or follow-up study (76380)
Unlisted CT procedure (76497)
CT angiography head (70496)
CT angiography neck (70498)
CT angiography chest (71275)
CT angiography pelvis (72191)
CT angiography arm (73206)
CT angiography leg (73706)
CT angiography abdomen and pelvis (74174)
CT angiography abdomen (74175)
Coronary CT angiography (75574)
CT angiography abdominal aorta with leg runoff (75635)
MR angiography head without contrast (70544)
MR angiography head with contrast (70545)
MR angiography head without and with contrast (70546)
MR angiography neck without contrast (70547)
MR angiography neck with contrast (70548)
MR angiography neck without and with contrast (70549)
MR angiography chest (71555)
MR angiography spinal canal (72159)
MR angiography pelvis (72198)
MR angiography arm (73225)
MR angiography leg (73725)
MR angiography abdomen (74185)
PET brain, metabolic evaluation (78608)
PET limited area (78811)
PET skull base to mid-thigh (78812)
PET whole body (78813)
PET/CT limited area (78814)
PET/CT skull base to mid-thigh (78815)
PET/CT whole body (78816)
Conducting a nuclear medicine test to evaluate thyroid function (78012)
Nuclear imaging of the thyroid in the neck that assesses blood flow (78013)
Conducting a nuclear medicine study to evaluate thyroid function (78014)
Nuclear imaging of the entire body for thyroid cancer assessment (78018)
Performing a nuclear evaluation of thyroid function in thyroid cancer (78020)
Executing a nuclear medicine study focused on the parathyroid (78070)
Nuclear imaging of the parathyroid in the neck using SPECT (78071)
Executing a nuclear medicine study of the parathyroid in the neck with CT and SPECT imaging (78072)
Imaging the adrenal glands using nuclear medicine techniques (78075)
Conducting a nuclear medicine study of a limited area of bone marrow (78102)
Nuclear imaging of the entire body to assess bone marrow (78104)
Conducting a nuclear medicine study to visualize the spleen (78185)
Nuclear imaging of the lymphatic system (78195)
Executing a nuclear medicine study focused on the liver (78201)
Assessing liver function and blood flow through nuclear imaging (78202)
Performing a nuclear medicine study to visualize the salivary gland (78230)
Performing nuclear imaging of the salivary gland using a series of images (78231)
Performing nuclear imaging to assess how the salivary gland works (78232)
Performing nuclear imaging to evaluate the motility of the esophagus (78258)
Conducting a nuclear medicine study to visualize the stomach lining (78261)
Carrying out a nuclear medicine study to evaluate gastric emptying (78264)
Executing a nuclear medicine assessment of gastric emptying along with small bowel transit (78265)
Nuclear imaging of the abdomen to evaluate stomach emptying and movement in the small and large bowel (78266)
Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss (78278)
Performing nuclear imaging to evaluate gastrointestinal protein loss (78282)
Conducting a nuclear medicine study to visualize the intestine (78290)
Performing nuclear imaging to evaluate the openness of a jugular to abdominal shunt (78291)
Nuclear imaging study of a limited area of bone or joint (78300)
Nuclear imaging study of multiple areas of bone or joint (78305)
Nuclear imaging study of the entire body for bone or joint assessment (78306)
Nuclear imaging of bone performed at various times (78315)
Nuclear imaging study to assess cardiovascular function in the heart (78414)
Nuclear imaging study to detect shunts in the heart (78428)
Performing nuclear imaging of the heart muscle alongside a CT scan (78429)
Performing nuclear imaging of heart muscle blood flow during rest and stress with a CT scan (78430)
Nuclear imaging of heart blood flow at rest and during stress with a CT scan (78431)
Conducting a nuclear medicine study to evaluate heart muscle and blood flow with two injections (78432)
Nuclear imaging of heart blood flow using PET technology (78434)
Performing nuclear imaging of heart muscle function at rest and during stress with SPECT (78451)
Performing nuclear imaging of heart muscle function at rest and during stress with multiple SPECT evaluations (78452)
Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image (78454)
Nuclear imaging of heart muscle that includes a metabolic evaluation (78459)
Nuclear imaging of heart muscle after a heart attack (78466)
Nuclear imaging of heart muscle after a heart attack, measuring blood volume ejected with each heartbeat (78468)
Nuclear imaging of heart muscle after a heart attack using SPECT (78469)
Nuclear imaging of heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles (78472)
Nuclear imaging to assess heart pumping function by tagging red blood cells and measuring blood volume ejected per beat over several cycles (78473)
First-pass nuclear medicine study to assess heart pumping function by measuring the blood volume ejected per beat during one cycle (78481)
Initial nuclear imaging assessing the heart's pumping function by measuring blood volume ejected per cycle (78483)
Analyzing blood circulation in heart muscle using nuclear medicine both at rest and under stress conditions (78491)
Nuclear medicine assessment of heart muscle blood flow at rest and under stress conditions (78492)
Nuclear imaging of heart pumping function, tracking red blood cells and measuring blood volume ejected with each heartbeat using SPECT (78494)
Nuclear imaging study of ventilation in the lungs (78579)
Nuclear imaging study of circulation in the lungs (78580)
Conducting a nuclear medicine study to assess lung ventilation and blood flow (78582)
Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine (78597)
Conducting a nuclear medicine study to assess lung ventilation and blood flow along with circulation (78598)
Nuclear imaging study of the brain with fewer than four static views (78600)
Performing nuclear imaging of the brain along with blood circulation evaluation (78601)
Carrying out a nuclear medicine study of the brain with four or more static views (78605)
Conducting a nuclear medicine study of the brain and its blood flow with four or more static views (78606)
Nuclear brain imaging using PET technology (78609)
Performing nuclear imaging to assess blood flow in the brain (78610)
Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine (78630)
Imaging cerebrospinal fluid flow in the brain and spinal cord's ventricles (78635)
Conducting a nuclear medicine study to assess cerebrospinal fluid flow for leakage detection (78650)
Carrying out a nuclear medicine study to evaluate the drainage of tear structures (78660)
Conducting a nuclear medicine study to image the kidney (78700)
Using nuclear imaging to evaluate the kidney along with its blood flow (78701)
Nuclear imaging study of the kidney, assessing blood flow and function without drug administration (78707)
Conducting a nuclear medicine study to evaluate kidney function and blood flow with the use of drugs (78708)
Conducting nuclear medicine studies to evaluate kidney function and blood flow (78709)
Nuclear imaging to assess kidney function (78725)
Carrying out a nuclear medicine study to assess urine retention in the bladder (78730)
Assessing urine flow through a nuclear medicine study (78740)
Performing nuclear imaging focused on testicular function and blood circulation (78761)
Nuclear imaging study of one area (78800)
Conducting a nuclear medicine study that examines several areas (78801)
Nuclear imaging study of the whole body (78802)
Nuclear imaging study using SPECT for one area (78803)
Nuclear imaging study of the whole body over multiple days (78804)
Nuclear imaging study using SPECT with a CT scan for one area (78830)
Nuclear imaging study using SPECT for at least two areas or multiple days (78831)
Nuclear imaging study using SPECT with a CT scan for at least two areas or multiple days (78832)
X-ray imaging with 3D rendering and interpretation (76376)
X-ray imaging with 3D rendering and computerized image postprocessing (76377)
An ultrasound scan of the brain is performed (76506)
A radiologist examines a two-dimensional ultrasound scan focused on the eye's tissue and structures (76512)
Ultrasound imaging of soft tissues in the head and neck (76536)
Ultrasound imaging of the chest (76604)
Complete ultrasound imaging of one breast (76641)
Limited ultrasound imaging of one breast (76642)
Ultrasound examination of the abdomen in its entirety (76700)
Ultrasound scan focusing on a limited area of the abdomen (76705)
Ultrasound scan focused on the abdominal aorta (76706)
Ultrasound imaging behind the abdominal cavity, fully assessed (76770)
Ultrasound scan behind the abdominal cavity with limited focus (76775)
Reviewing an ultrasound of the spinal canal (76800)
Conducting a transvaginal ultrasound examination of the uterus and surrounding structures (76830)
Carrying out an ultrasound scan focused on the uterus and its cavity (76831)
Comprehensive ultrasound assessment of the pelvic area (76856)
Limited ultrasound examination of the pelvic region (76857)
Ultrasound imaging of the scrotum (76870)
Ultrasound imaging of the pelvic area through the rectum (76872)
Performing a thorough ultrasound examination of a joint (76881)
Limited ultrasound assessment of a joint or other structure in the extremity, not including blood vessels (76882)
Conducting an ultrasound of an infant's hip while moving (76885)
Conducting a static ultrasound examination of the hip in an infant (76886)
Ultrasound guidance for needle placement during a biopsy (76942)
An ultrasound scan with contrast is performed for the first growth (76978)
Performing an ultrasound examination with contrast for each additional growth (76979)
Ultrasound imaging is used to measure the elasticity of organ tissue (76981)
An ultrasound scan is performed to measure the elasticity of the first growth (76982)
Ultrasound imaging is used for guidance during surgery (76998)
Conducting a heart stress test induced by exercise or medication with an ECG (93015)
Performing ultrasound imaging of the heart to check for congenital defects (93303)
Follow-up ultrasound imaging of the heart for congenital defects (93304)
Using ultrasound to examine the heart with color flow and valve function analysis (93306)
Ultrasound imaging of the heart (93307)
Follow-up ultrasound imaging of the heart (93308)
Conducting ultrasound of the heart with a probe placed in the esophagus (93312)
Inserting a probe in the esophagus for heart ultrasound imaging (93313)
Interpreting and reporting an ultrasound of the heart (93314)
Performing 3D ultrasound imaging of the heart to evaluate its structure during congenital heart defect assessment (93319)
Performing an ultrasound examination of the heart's chambers, valves, and blood flow (93320)
Conducting a follow-up ultrasound assessment of the heart's valves, chambers, and blood flow (93321)
Using ultrasound with color imaging to show blood flow and valve function in the heart (93325)
Performing an ultrasound of the heart while at rest, during exercise, or under drug-induced stress (93350)
Performing an ultrasound of the heart while monitoring ECG during rest, exercise, or drug-induced stress (93351)
Using ultrasound with a probe in the esophagus during heart or great vessel surgery, along with a report (93355)
Imaging strain in the heart muscle (93356)
Inserting a tube into the right heart chambers to measure pressures (93451)
Inserting a tube into the left heart chambers for diagnostic purposes with ventriculography reviewed by a radiologist (93452)
Inserting catheters into both sides of the heart to measure pressures (93453)
Inserting a tube into a coronary artery for diagnostic angiography, reviewed by a radiologist (93454)
Heart catheterization procedure (93458)
Inserting a tube into both ventricles and a coronary artery for diagnostic angiography, reviewed by a radiologist (93460)
Inserting a tube in both ventricles, a coronary artery, and a bypass graft for diagnostic angiography, reviewed by a radiologist (93461)
Injecting a contrast agent for imaging of coronary arteries during congenital abnormality evaluation (93563)
Injecting a contrast agent for imaging of the left heart chambers with radiologist review (93565)
Injecting for imaging of the heart's right chambers (93566)
Injecting for imaging of the aorta above the heart valve (93567)
Performing an injection for imaging the pulmonary artery in a nonselective manner during heart catheterization (93568)
Inserting a catheter into the right side of the heart for evaluating a congenital heart defect using imaging guidance (93593)
Ultrasound imaging of blood flow in both sides of the head and neck (93880)
Ultrasound imaging of blood flow in one side of the head and neck (93882)
Complete ultrasound imaging of blood flow in the head's brain area (93886)
Ultrasound imaging of blood flow within the brain (93888)
Imaging the arteries in the arm and leg using ultrasound (93922)
Conducting a complete ultrasound study of the arteries in the arm and leg (93923)
Using ultrasound to examine leg arteries on both sides, both at rest and after activity (93924)
Performing an ultrasound study on leg arteries or their grafts (93925)
Imaging one leg's arteries or artery grafts using ultrasound (93926)
Performing an ultrasound study of the arteries in the arm (93930)
Imaging one arm's arteries or artery grafts using ultrasound (93931)
Ultrasound imaging of veins in the arm or leg using compression and movements (93970)
Ultrasound imaging of veins in one arm or leg using compression and movements (93971)
Ultrasound imaging of blood flow in arteries and veins of the abdomen and pelvis (93975)
Ultrasound imaging of blood flow in the abdomen and pelvis area (93976)
Complete ultrasound imaging of blood flow in the penis's arteries and veins (93980)
Conducting a bilateral ultrasound assessment of blood flow in arteries and veins for hemodialysis (93985)
Ultrasound imaging of access for hemodialysis (93990)
Biopsy of each additional breast growth with a locating device using ultrasound (19084)
Biopsy of the first breast growth with a locating device using MRI (19085)
Biopsy of each additional breast growth with a locating device using MRI (19086)
Performing a core needle biopsy of the lung or mediastinum through the skin (32408)
Inserting a pacemaker's pulse generator with one existing lead (33212)
Embolizing or blocking growths or obstructed vessels, reviewed by a radiologist (37243)
Using ultrasound to measure bladder capacity after voiding (51798)
A radiologist reviews X-ray images of the bladder and urethra with contrast after urination (74455)
A radiologist reviews X-ray images of the uterine tube and ovary (74740)
X-ray imaging of the lymphatic system in the arm or leg reviewed by a radiologist (75801)
X-ray imaging for draining fluid from an abscess (75989)
CT scan used for locating a needle or tube (77011)
CT imaging is reviewed by a radiologist for needle biopsy guidance (77012)
Radiologist reviews MRI imaging for needle placement guidance (77021)
Measuring stiffness of the liver (91200)
Payer
Aetna Anthem BCBS Cigna UnitedHealthcare Humana A Medicare Advantage plan Medicaid managed care plan Other
Payer name, if "Other" (optional) Guideline section cited or expected (optional, e.g. SP-5.1)
Reason given for the denial
Conservative treatment not documented or not long enough Clinical documentation missing or incomplete Guideline criteria not met Not medically necessary Diagnosis code does not support the study Required earlier imaging not done Other or unclear
Denial wording, if you want to quote it (optional)
