In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.

This is to update providers of the claim review findings for CPT® 72148: Magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.

The Jurisdiction E, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 72148: Magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material. The quarterly edit effectiveness results from October 1, 2025, through December 31, 2025, are as follows:

Top Denial Reasons

• Denial Reason 1 - Failure to return records
• Denial Reason 2 - Documentation submitted was incomplete and/or insufficient
• Denial Reason 3 - The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination

Educational Resources

• Failure to Return Records
• Documentation and Coding that Demonstrates Medical Necessity
• LCD L34220 - Lumbar MRI
• LCA A57206 - Lumbar MRI

Education

CPT® code 72148 is reported for Magnetic Resonance Imaging (MRI) diagnostic imaging of the lumbar spine without contrast. If contrast is used for the procedure, report CPT® 72149. This diagnostic imaging procedure is used to evaluate conditions such as disc herniation, spinal stenosis, early detection of osteomyelitis, and other abnormalities of the lumbar spine.

Spinal imaging tests are not necessary during the first month of symptoms except when a "red flag" (suggesting a medically emergent condition) is noted on the medical history and physical examination. For a "non-red flag" condition, the MRI may be appropriate after one month of symptoms. When a lumbar MRI is ordered, Medicare expects that the information gained from the test will be used for medical decision-making.

Measurement of blood flow, spectroscopy, imaging of cortical bone and calcifications, and procedures involving spatial resolution of bone or calcifications are considered investigational and therefore not covered.

The technical component (TC) cannot be performed without the professional component (PC). Typically, only one PC is payable. However, a second PC may be reasonable and necessary if an additional physician expertise is required to diagnose and treat the patient or clarify a questionable finding.

National Coverage Determination "Magnetic Resonance Imaging" discusses the coverage requirements for these services. This can be located within the Internet-Only Manuals (IOM), Medicare National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Part 4, Section 220.2.