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Molina Clinical Review Advanced Imaging (MCR - AI)

Molina has established Molina Clinical Review Advanced Imaging that function as one of the sets of guidelines for coverage decisions or determinations. In this site, the Molina Clinical Review Advanced Imaging is made accessible to you to guide you in your medical decisions. Please know that these Clinical Reviews do not constitute plan authorization, nor is it an explanation of benefits.

Molina Clinical Review

Date Last Updated

Date Originally Approved

MCR-070 Oral and Tube Fed Enteral Nutrition

04/03/2018

10/11/2007

MCR 74176 and 74177 and 74178 AbdomenPelvis CT

11/7/2017

11/7/2017

MCR-600 Brain CT

11/7/2017

11/7/2017

MCR-601 Brain MRI

11/7/2017

11/7/2017

MCR-602 Chest CT

11/7/2017

11/7/2017

MCR-603 Shoulder MRI

11/7/2017

11/7/2017

MCR-604 Knee MRI

11/7/2017

11/7/2017

MCR-607 Cervical Spine CT

11/7/2017

11/7/2017

MCR-607 Cervical Spine MRI

11/7/2017

11/7/2017

MCR-608 Thoracic Spine MRI

11/7/2017

11/7/2017

MCR-608 Thoracic Spine CT

11/7/2017

11/7/2017

MCR-609 Lumbar Spine MRI

11/7/2017

11/7/2017

MCR-610 PET Scan With or Without CT Attenuation

11/7/2017

11/7/2017

MCR-612 Lumbar Spine CT

11/7/2017

11/7/2017

MCR-613 Ankle MRI

11/7/2017

11/7/2017

MCR-614 Hip MRI

11/7/2017

11/7/2017

MCR-615 Elbow MRI

11/7/2017

11/7/2017

MCR-616 Wrist MRI

11/7/2017

11/7/2017

MCP-617 Abdomen MRI

11/7/2017

11/7/2017

MCR-618 Pelvic MRI

11/7/2017

11/7/2017

MCR-619 Abdomen CT

11/7/2017

11/7/2017

MCR-620 Pelvic CT

11/7/2017

11/7/2017

MCR-621 Chest CTA

11/7/2017

11/7/2017

MCR-622 Chest MRA

11/7/2017

11/7/2017

MCR-635 Abdomen

11/7/2017

11/7/2017

MCR-638 Abdomen Pelvis CT

11/7/2017

11/7/2017

MCR-639 Abdomen MRI

11/7/2017

11/7/2017

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