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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Musculoskeletal Imaging

CT Bone Density Study
CT Pelvis
Computed Tomography (CT) Spine (Cervical, Thoracic, Lumbar)
CT Lumbar Spine
CT Cervical Spine
CT Lower Extremity (Ankle, Foot, Hip or Knee)
Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) of the Spine

Indicates Non-covered Service

Aetna
FloridaBlue
Aetna
CT Thoracic Spine
Computed Tomography (CT) Extremity (Upper and Lower)
CT Upper Extremity
FloridaBlue
Whole Body Computed Tomography Scan as a Screening Test
MRI of the Ankle & Hindfoot
MRI of the Hip Joint
MRI of the Knee
MRI of the Elbow
MRI Bone Marrow
MRI Cervical Spine
Humana
FloridaBlue
Humana
Humana
Humana
Humana
MRI Lower Extremity
MRI of the Spine
Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) of the Spine
MRI of the Shoulder
MRI Lumbar Spine
MRI 
Pelvis
MRI Thoracic Spine
Aetna
Aetna
FloridaBlue
Humana
Aetna
FloridaBlue
MRI Upper Extremity
Magnetic Resonance Spectroscopy for Discogenic Pain
MRI Low Field
Magnetic Resonance Spectroscopy
MRI Upper Extremity, other than Joint
MRI Wrist
Positional MRI
FloridaBlue
Humana
Humana
Videofluoros-copy, Dynamic MRI for Musculoskel-etal Indications
Humana
Nuclear Medicine Imaging
Anthem
Bone & Joint SPECT
SPECT Scan for Evaluation of Spondylolysis, Spondylolisthesis & Skeletal Disorders
Single Photon Emission Computed Tomography (SPECT)
Aetna
Spinal Ultrasonography
UHC
3D Interpretation & Reporting of Imaging Studies
Bone Mineral Density Studies
FloridaBlue
Humana
Thermography
Whole Body Dual X-ray Absorptiometry (DEXA) to Determine Body Composition
Computerized Motion Diagnostic Imaging
UHC
Aetna
Aetna
Advanced Imaging of the Ankle
Advanced Imaging of the Hand
Advanced Imaging of the Hip
Advanced Imaging for Ganglion Cysts
Advanced Imaging of the Elbow
Advanced Imaging of the Knee
Advanced Imaging of Chondral/
Osteochondral Lesions, Including Osteochondritis Dissecans & Fractures
Advanced Imaging of the Pelvis
Symptom Based Spine Imaging
Diagnosis Based Bone & Joint Pelvic Imaging
Avascular Necrosis (AVN)/ Osteonecrosis Imaging
Advanced Imaging of the Wrist
Advanced Imaging of the Shoulder
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