All PlansCoverageMedium impact
Healthcare Effectiveness and Data Information Set: Measure for Use of Imaging Studies for Low Back Pain
Cigna·Family Medicine, Internal Medicine, Orthopedics +4 more·Quality Measures
Effective date
Nov 5, 2024
We identified it
Jun 19, 2026
Summary
Cigna Healthcare has updated their HEDIS quality measure for low back pain imaging, emphasizing that imaging studies (X-rays, MRI, CT scans) should not be performed within 28 days of initial diagnosis unless red flags are present. The policy promotes alternative treatments and indicates Cigna is tracking increased inappropriate imaging trends.
Action Required
Immediately: Providers should review low back pain treatment protocols to avoid ordering imaging studies within 28 days of diagnosis unless red flags are present. Consider alternative treatments first (physical therapy, NSAIDs, exercises). Document medical necessity if imaging is required within the 28-day window to support quality measure reporting and potential claim reviews.