Magnetic Resonance Cholangiopancreatography (CPB 0384, reviewed 2026-06-25)

Before June 25, 2026: (1) Billing team must update claims submission system to enforce prior authorization requirements for MRCP (S8037) and require documentation of one of the 12 listed medical necessity criteria. (2) Configure system to automatically deny or escalate CPT codes 0723T and 0724T (quantitative MRCP) with denial message stating these are experimental/investigational per policy CPB 0384. (3) Update provider encounter templates and billing guidelines to reference the 12 covered indications: preoperative CBD evaluation, diagnostic-only suspected pathology, iodine allergy/atopy, altered biliary anatomy, failed ERCP, unsafe ERCP candidates, proximal anatomy definition, congenital anomaly evaluation, liver transplant recipients, disrupted pancreatic duct in pancreatitis, PSC diagnosis/monitoring, and pancreatic cancer diagnosis/staging/surveillance, and IPMN postsurgical surveillance. (4) Train billing and prior auth staff on the specific ICD-10 diagnosis codes that support coverage (K80.00-K80.81, K82.0, K83.01-K83.9, K85.00-K86.9, C25.0-C25.9, Q44.0-Q44.79, etc.) and which codes do NOT support coverage (K70.0-K77, K81.0-K81.9). (5) Communicate with providers that claims without documented alignment to one of the 12 criteria will be denied as not meeting medical necessity. Failure to implement these controls will result in claim denials and potential overpayment recovery.