Best Practice Advice
ÎÎDiagnostic imaging studies should be performed only
in selected, higher-risk patients who have severe or
progressive neurologic deficits or who are suspected of
having a serious or specific underlying condition.
ÎÎAdvanced imaging with MRI or CT should be reserved for
patients with a suspected serious underlying condition
or neurologic deficits, or who are candidates for invasive
interventions.
ÎÎDecisions about repeated imaging should be based on
development of new symptoms or changes in current
symptoms.
ÎÎPatient education strategies should be used to inform
patients about current and effective standards of care.
Table 3. Cost of Low Back Imaging
Reimbursement, $
Range of Estimated Charges, $
50
204-286 (in network),
404-565 (out of network)
Lumbar spine CT
381 (without contrast),
459 (with contrast)
1082-1517 (in network),
2091-2928 (out of network)
Lumbar spine MRI
715 (without contrast),
863 (with contrast)
877-1226 (in network),
1762-2467 (out of network)
Intervention
Lumbar spine radiography
Table 4. Summary of the American College of Physicians Best
Practice Advice: Diagnostic Imaging for LBP
Disease or Condition
Imaging for LBP
Target audience
Internists, family physicians, and other clinicians
Target patient population
Adults with LBP
Interventions
Radiography, CT, MRI
Indications for diagnostic
imaging
> Immediate imaging is recommended in patients with acute
LBP who have major risk factors for cancer, risk factors for
spinal infection, risk factors for or signs of the cauda equina
syndrome, or severe or progressive neurologic deficits.
> Imaging after a trial of therapy is recommended in
patients with minor risk factors for cancer, risk factors
for inflammatory back disease, risk factors for vertebral
compression fracture, signs or symptoms of radiculopathy, or
risk factors for or symptoms of symptomatic spinal stenosis.
> Repeated imaging is only recommended in patients with
new or changed low back symptoms.
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