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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
Whole Body Computed Tomography Screening Test
Computed Tomography (CT) Extremity (Upper & Lower)
CT Upper Extremity
FloridaBlue
Magnetic Resonance Imaging (MRI) of the Ankle and Hindfoot
MRI Hip
MRI Knee
MRI Elbow
MRI Bone Marrow
MRI Cervical Spine
Humana
FloridaBlue
Humana
Humana
Humana
Humana
MRI) Lower Extremity
MRI Spine
Magnetic Resonance Imaging (MRI) & Computed Tomography (CT) of the Spine
MRI 
Shoulder
MRI Lumbar Spine
MRI Pelvis
MRI Thoracic Spine
FloridaBlue
Humana
Aetna
FloridaBlue
Aetna
Aetna
MRI) Upper Extremity
MRI Upper Extremity
MRI Wrist
FloridaBlue
Magnetic Resonance Spectroscopy
Videofluoroscopy, Dynamic MRI for Musculoskel-etal Indications

Positional

 MRI

Magnetic Resonance Spectroscopy for Discogenic Pain
MRI Low Field
Humana
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
Computerized Motion Diagnostic Imaging
Thermography
Whole Body Dual X-ray Absorptiometry (DEXA) to Determine Body Composition
Aetna
Aetna
UHC
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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