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Cardiovascular Magnetic Resonance Imaging

Approved: 3/07
Reviewed: 2/08, 3/10, 2/11, 1/12, 1/13, 3/14, 2/15, 1/16, 1/17
Revised: 1/09, 1/16

 

For enrollees who cannot be adequately imaged with echocardiograms, Cardiovascular Magnetic Resonance Imaging (MRI) can be an effective method for evaluating the heart and great vessels.  

 

MRI of the cardiovascular system is considered medically necessary for the following conditions:

  1. Diseases of the thoracic large veins and arteries
  2. Pericardial disease
  3. External or internal cardiac or vascular masses
  4. Assessment of arrhythmogenic right ventricular dysplasia
  5. Assessment of siderotic cardiomyopathy
  6. Congenital heart disease assessment and follow up, including, but not limited to septal defects, anomalous coronaries, hypertrophic cardiomyopathy, non-compaction and palliative, and corrective shunts
  7. Cardiac function, morphology and structure when echocardiogram is inconclusive or precise volumes, mass and ejection fraction are required
  8. Evaluation of the right heart, including size, structure, function, and pulmonary hypertension
  9. Valvular heart disease when echocardiogram is inconclusive or precise quantification of valvular regurgitation and chamber size is necessary to appropriately time intervention
  10. To demonstrate the presence and complications of acute or chronic myocardial infarction, and myocardial viability
  11. To differentiate the etiology of dilated cardiomyopathy, particularly when coronary disease is not suspected and cardiac catheterization may be avoided, and to evaluate for infiltrative cardiomyopathies, such as amyloidosis, sarcoidosis, or myocarditis
  12. In situations when nuclear perfusion or stress echocardiography may otherwise be considered, and additional information including structure, function, and viability is clinically relevant or when discordant information is obtained from other modalities, or the enrollee had an uninterpretable electrocardiogram or is unable to exercise.
  13. Evaluation of the left atrium and pulmonary vein anatomy and function prior to cardiac ablation.
  14. Evaluation for myocarditis.

 

ConnectCare considers MRI of the cardiovascular system experimental and investigational as a screening test. 

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.