Best Practice Advice
ÎDiagnostic 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.
ÎAdvanced 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.
ÎDecisions about repeated imaging should be based on development of new symptoms or changes in current symptoms.
ÎPatient education strategies should be used to inform patients about current and effective standards of care.
Table 3. Cost of Low Back Imaging Intervention
Lumbar spine radiography Lumbar spine CT Lumbar spine MRI
Reimbursement, $ Range of Estimated Charges, $ 50
204-286 (in network), 404-565 (out of network)
381 (without contrast), 459 (with contrast)
715 (without contrast), 863 (with contrast)
1082-1517 (in network), 2091-2928 (out of network)
877-1226 (in network), 1762-2467 (out of network)
Table 4. Summary of the American College of Physicians Best Practice Advice: Diagnostic Imaging for LBP
Disease or Condition Target audience
Imaging for LBP Internists, family physicians, and other clinicians
Target patient population Adults with LBP Interventions
Indications for diagnostic imaging
Radiography, CT, MRI
> 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 aſter 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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