Category 1
Category 2
Category 3
100

This modality is preferred for those with HA if they have a hx of cancer or are immunocompromised. 

What is MRI?

100

This guideline can be used for a member with HA while on Coumadin

What is HD-11.9?
100

In addition to HD-11.2, this guideline would be applicable if patient was having an acute mental status change and headaches

What is HD-4.2?

200

This guideline should be used for a 70 yo with new onset headaches

What is HD-11.7?

200

This guideline should be used for an 18 yo with exertional headache

What is PEDHD-3.1?

200

This guideline can be used for a headache that started when the patient was bending over

What is HD-11.11 Physical Exertion?

300

This guideline can be used for a member with cluster headaches

What is HD-11.4?

300

This guideline should be used for member complaining of headache and the rule out in intracerebral hemorrhage. 

What is HD-21.1?
300

This guideline can be used for a member with HA waking up from sleep

What is HD-11.3?

400

One of these studies may be approved in addition to CT or MRI Brain if the patient had a thunderclap headache. 

What is CTA or MRA Head?

400

This guideline can be used for migraines 

What is HD-11.17?

400

This guideline should be applied when a MRI Cervical Spine is being requested for cervicogenic headaches and there are no bony abnormalities, red flags or signs of myelopathy. 

What is SP-3.1?

500

This guideline should be applied if they are following up on a VP shunt

What is HD-11.14?

500

The immediate post partum period is defined as this many months after delivery within one of the headache guidelines.

What is 3 months?

500

This guideline should be used for a member with headaches and dizziness

What is HD-11.2?

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