CommercialCoverageMedium impact
Magnetic Resonance Spectroscopy (MRS) 6.01.03
Excellus BlueCross BlueShield·Radiology, Neurology, Neurosurgery +1 more·Radiology (x-rays) & Imaging
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their MRS policy effective May 15, 2026, defining specific medically appropriate uses for brain imaging while marking all spine applications as not medically necessary. The policy establishes clear criteria for when MRS can be billed and provides specific CPT codes with coverage designations.
Action Required
Before May 15, 2026: Billing team must review all MRS claims to ensure they meet the new medical necessity criteria - only bill CPT 76390 for approved brain conditions when conventional MRI/CT provides limited information. Stop billing spine-related MRS procedures (codes 0609T, 0610T, 0611T) as these are marked not medically necessary. Update prior authorization workflows to verify one of the six specific approved indications before billing.