All PlansCoverageMedium impact
Avoid Imaging for Low Back Pain When Not Indicated
BCBS New Mexico·NM · Family Medicine, Internal Medicine, General Practice +5 more·General
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of New Mexico issued guidance discouraging imaging studies (X-rays, MRI, CT scans) within 28 days for uncomplicated low back pain in patients ages 18-75, emphasizing conservative treatment first. This affects HEDIS quality measures and may impact prior authorization requirements for imaging services.
Action Required
Immediately: Providers should avoid ordering imaging studies (X-rays, MRI, CT scans) for new-onset uncomplicated low back pain patients ages 18-75 during first 28 days unless underlying conditions are suspected. Always verify eligibility and prior authorization requirements through Availity Essentials before ordering advanced imaging. Use complete and accurate exclusion codes when applicable - refer to Quality Care 2026 booklet in Availity Essentials for specific codes.