Cerebrovascular diseases/disorders/injuries.Magnetic resonance spectroscopy (MRS) (also known as NMR spectroscopy) is considered experimental and investigational for all other indications, including the following (not an all-inclusive list) because there is a lack of reliable evidence of its efficacy for these indications in the medical literature: Note: MRS is considered medically necessary for disease monitoring of these diagnoses when recent MRI findings are inconclusive and a change in therapy is being considered. Vanishing White Matter disease (Leukoencephalopathy with vanishing white.Megalencephalic leukoencephalopathy with subcortical cysts.

Alexander disease (ALX, AXD, demyelinogenic leukodystrophy).Leigh’s syndrome, Kearns-Sayre syndrome, MELAS, et al) X-linked adrenoleukodystrophy (X-ALD, CALD).Globoid Cell Leukodystrophy (Krabbe disease).Hypomyelination and Congenital Cataract.Diagnosis and monitoring of the following metabolic disorders:.Distinguishing recurrent brain tumor from radiation-induced tumor necrosis.Evaluate a brain lesion of indeterminate nature when the MRS findings will be used to determine whether biopsy/resection can be safely postponed.

Distinguishing low grade from high grade gliomas.Assessing prognosis in hypoxic ischemic encephalopathy.This Clinical Policy Bulletin addresses magnetic tesonance dpectroscopy (MRS).Īetna considers magnetic resonance spectroscopy (MRS) (also known as NMR spectroscopy) medically necessary for the following indications:

Number: 0202 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References

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