All PlansCoverageMedium impact
Avoid Imaging for Low Back Pain When Not Indicated
BCBS Montana·MT · Family Medicine, Internal Medicine, General Practice +4 more·General
Effective date
Jun 2, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of Montana is tracking a HEDIS quality measure that discourages imaging studies (X-ray, MRI, CT) within 28 days of low back pain diagnosis for patients ages 18-75. Providers should avoid ordering diagnostic imaging for the first four weeks of new-onset, uncomplicated back pain and focus on conservative treatment instead.
Action Required
By June 2, 2026: Providers must avoid ordering X-ray, MRI, or CT scans within 28 days of diagnosing uncomplicated low back pain in patients ages 18-75. Clinical staff should verify eligibility and prior authorization requirements through Availity Essentials before ordering advanced imaging. Update EMR templates to include conservative treatment education and ensure proper coding with exclusion codes when indicated. Reference the Quality Care 2026 booklet in Availity Essentials for specific codes.