{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:22:05Z","timestamp":1787671325803,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2023,1,15]]},"abstract":"<jats:p>The American College of Radiology has published appropriateness criteria to help guide when to use MRI. Many health insurance carriers use proprietary clinical guidelines for prior authorization of imaging studies. The purpose of this study was to compare the specific criteria in those guidelines, for neck pain both with and without radicular symptoms. An online search was conducted to identify the guidelines for authorization of cervical spine MRI used by the largest commercial insurance carriers in the United States by market share. Guidelines were analyzed for neck pain with and without radiculopathy. Cervical trauma, myelopathy, infection, neoplasm, multiple sclerosis, and postprocedural care were excluded. The remaining criteria were broken down into categories including clinical symptoms, conservative therapy, other required radiologic studies, and clinical re-evaluation. Individual criteria within each of the categories were compared. After evaluation of the top 56 insurance companies in the United States, 30 companies using four main utilization management companies remained for analysis. After direct comparison of publicly available guidelines documents, notable discrepancies existed between the four companies in all subcategories analyzed. In addition, varying amounts of evidence-based literature was identified to support criteria requirements for prior authorization. This study demonstrates that the guidelines used by private health insurance companies for cervical MRI authorization in the setting of neck pain with and without cervical radiculopathy are inconsistent and use objective measures that have not been validated in the literature. We think this warrants additional scrutiny and investigation.<\/jats:p>","DOI":"10.5435\/jaaos-d-22-00517","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T11:06:45Z","timestamp":1672312005000},"page":"64-70","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Clinical Guidelines for Authorization of MRI in the Evaluation of Neck Pain and Cervical Radiculopathy in the United States"],"prefix":"10.5435","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-474X","authenticated-orcid":false,"given":"Daniel","family":"Berman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Holtzman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Sharfman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5177-8750","authenticated-orcid":false,"given":"Nathaniel","family":"Tindel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250503","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1097\/BRS.0b013e3181c17067","article-title":"Age-related changes of thoracic and cervical intervertebral discs in asymptomatic subjects","volume":"35","author":"Matsumoto","year":"2010","journal-title":"Spine"},{"key":"R2-20250503","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1302\/0301-620X.80B1.0800019","article-title":"MRI of cervical intervertebral discs in asymptomatic subjects","volume":"80-B","author":"Matsumoto","year":"1998","journal-title":"J Bone Joint Surg Br"},{"key":"R3-20250503","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/brain\/117.2.325","article-title":"Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990","volume":"117","author":"Radhakrishnan","year":"1994","journal-title":"Brain"},{"key":"R4-20250503","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1056\/NEJMhpr0808703","article-title":"Health insurers and medical-imaging policy--a work in progress","volume":"360","author":"Iglehart","year":"2009","journal-title":"N Engl J Med"},{"key":"R5-20250503","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1471-2342-13-40","article-title":"National trends in advanced outpatient diagnostic imaging utilization: An analysis of the medical expenditure panel survey, 2000-2009","volume":"13","author":"Lang","year":"2013","journal-title":"BMC Med Imaging"},{"key":"R6-20250503","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1148\/radiol.2019191116","article-title":"Trends in diagnostic imaging utilization among Medicare and commercially insured adults from 2003 through 2016","volume":"294","author":"Hong","year":"2020","journal-title":"Radiology"},{"key":"R7-20250503","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1016\/j.jacr.2019.02.023","article-title":"ACR appropriateness criteria((R)) cervical neck pain or cervical radiculopathy","volume":"16","author":"McDonald","year":"2019","journal-title":"J Am Coll Radiol"},{"key":"R8-20250503","first-page":"CD004250","article-title":"Exercises for mechanical neck disorders","volume":"1","author":"Gross","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"R9-20250503","first-page":"33","article-title":"Cervical radiculopathy: Nonoperative management of neck pain and radicular symptoms","volume":"81","author":"Eubanks","year":"2010","journal-title":"Am Fam Physician"},{"key":"R10-20250503","first-page":"746","article-title":"Nonoperative management of cervical radiculopathy","volume":"93","author":"Childress","year":"2016","journal-title":"Am Fam Physician"},{"key":"R11-20250503","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00003086-199707000-00014","article-title":"Value of cervical spine radiographs as a screening tool","volume":"340","author":"Johnson","year":"1997","journal-title":"Clin Orthop Relat Res"},{"key":"R12-20250503","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3233\/BMR-140488","article-title":"Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic","volume":"28","author":"Leichtle","year":"2015","journal-title":"J Back Musculoskelet Rehabil"},{"key":"R13-20250503","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.clinimag.2020.08.006","article-title":"Lifetime attributable risk of cancer incidence and mortality in routine digital radiology procedures","volume":"67","author":"Zangeneh","year":"2020","journal-title":"Clin Imaging"},{"key":"R14-20250503","doi-asserted-by":"crossref","first-page":"358","DOI":"10.2214\/AJR.13.11123","article-title":"The choosing wisely initiative of the American board of internal medicine foundation: What will its impact be on radiology practice?","volume":"202","author":"Rao","year":"2014","journal-title":"Am J Roentgenol"},{"key":"R15-20250503","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.3174\/ajnr.A4821","article-title":"Neuroimaging wisely","volume":"37","author":"Buethe","year":"2016","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-22-00517","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:41:54Z","timestamp":1787668914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-22-00517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,15]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-22-00517","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,15]]},"assertion":[{"value":"2022-05-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}