MRA of the head may be considered medically necessary for the assessment of:
ï· patients suspected of having steno-occlusive disease of the mid or large size intracranial arteries;
ï· patients suspected of having cerebral aneurysm;
ï· patients suspected of having intracranial vascular malformation;
ï· patients suspected of having cerebral venous sinus compression or thrombosis;
ï· patients with pulsatile tinnitus;
MRA of the neck may be considered medically necessary for the assessment of:
ï· patients suspected of having carotid stenosis or occlusion;
ï· patients suspected of having cervicocranial arterial dissection.
MRA of the abdomen/pelvis may be considered medically necessary for the assessment of patients with the following clinical indications in whom angiography would otherwise be indicated and in whom a negative MRA would obviate the need for angiography:
ï· patients suspected of having atherosclerotic renal artery stenosis;
ï· patients with suspected chronic mesenteric ischemia;
ï· patients with abdominal aortic aneurysm who are to undergo elective repair of the aneurysm;
ï· patients requiring evaluation of the portal and/or hepatic venous system; patients requiring evaluation of the systemic venous system.
MRA of the pelvis/lower extremities may be considered medically necessary for the assessment of patients with the following clinical indications:
ï· patients with suspected atherosclerotic disease of the lower extremity in whom angiography would otherwise be indicated and in whom MRA would obviate the need for angiography;
ï· patients with known atherosclerotic disease of the lower extremity who are being evaluated for bypass surgery and in whom angiography fails to identify runoff vessels suitable for bypass.
MRA may be considered medically necessary in the evaluation of potential renal donors for the presence of accessory renal arteries.
