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MRI prior authorization for renal hypertension

Updated: Jul 21, 2023

Is Preauth Required? Preauthorization is required for an MRI to treat renal hypertension if the hypertension is refractory, of recent onset, or requires a sudden increase in antihypertensive medication to control.

Will the claim be denied? Claims for MRI will be denied for renal hypertension, as MRI is not an accepted treatment for this condition. Non-invasive imaging studies such as duplex ultrasonography, MRA, or CTA are recommended for the diagnosis of renal artery stenosis.

When is the following treatment medically necessary for the condition specified? An MRI is considered medically necessary for the condition of renal hypertension if there is a prior non-invasive renal artery study that is inconclusive or unavailable, or if there is severe or difficult to control renal hypertension, progressive renal insufficiency, or the patient has a need for surgical or percutaneous correction of the occlusive disease that would be beneficial to their clinical status.

What would make the following treatment considered medically necessary? MRI is not considered medically necessary for the condition of renal hypertension. The LCD indicates that for renal hypertension, the medically necessary treatments are stand-alone renal angiography or surgical or percutaneous correction of the occlusive disease.

What are the relevant codes for the treatment? HCPCS codes C8900-C8902 should be reported for MRI of the abdomen. CPT code 74185 applies only for Part B claims. ICD-10-CM codes I11.0, I13.0, and I13.2 should be used to support medical necessity.

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