All PlansCoverageMedium impact
Avoid Imaging for Low Back Pain When Not Indicated
BCBS Texas·TX · Family Medicine, Internal Medicine, Orthopedics +4 more·General
Effective date
Jun 2, 2026
We identified it
Jun 3, 2026
Summary
Blue Cross Blue Shield of Texas is tracking a HEDIS quality measure for appropriate low back pain imaging, discouraging X-rays, MRIs, or CT scans within 28 days of diagnosis for uncomplicated cases in patients ages 18-75. Providers should focus on conservative treatment first and verify prior authorization requirements for advanced imaging.
Action Required
Immediately: Providers should avoid ordering diagnostic imaging (X-ray, MRI, CT) within 28 days for new-onset uncomplicated low back pain in patients ages 18-75. Billing team must always verify eligibility and prior authorization requirements through Availity Essentials before advanced imaging services. Reference Quality Care 2026 booklet for complete exclusion codes and ensure accurate coding when billing for back pain cases.