Magnetic resonance cholangiopancreatography (MRCP) is considered medically necessary for the diagnostic evaluation of the pancreatobiliary system when: 

• there is a low likelihood that the patient will need a therapeutic intervention or tissue sampling with endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC),
  
  
• ERCP has been technically unsuccessful, or
  
  
• ERCP is considered unsafe or very unlikely to be successful (examples include but are not limited to, pediatric patients, or when there are major medical comorbidities, or complex pancreatobiliary anatomy such as post biliary-enteric bypass).

MRCP for conditions other than those listed are considered not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service in this instance. 

Description

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for imaging the biliary and pancreatic ducts using magnetic resonance imaging (MRI). It can be performed as an alternative to more invasive imaging procedures such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), or intravenous cholangiography (IVC). For example, MRCP is able to visualize the ducts beyond an obstructing lesion whereas this may be difficult with ERCP or PTC.

To perform MRCP, specialized MRI imaging sequences are used to make the fluid in the ducts appear bright while the surrounding organs and tissues are suppressed and appear dark. Rapid imaging reduces the motion artifact. This method also provides sufficient resolution to detect small ductal structures and pathology. MRCP can be performed on commercially available magnetic resonance machines using FDA-approved software products as appropriate.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

National Blue Cross Blue Shield Medical Policy # 6.01.42

MR Cholangiopancreatography, Radiologic Clinics of North America, Vol. 40, No. 6, December 2002

MR Cholangiopancreatography: evaluation of common pancreatic diseases, Radiologic Clinics of North America, Vol. 41, No. 1, January 2003

MR Cholangiopancreatography, Radiologic Clinics of North America, Vol. 41, No. 1, January 2003

Usual and unusual causes of extrahepatic cholestasis: assessment with magnetic resonance cholangiography and fast MRI, Abdominal Imaging, Vol. 29, January-February 2004

MR Cholangiopancreatography: improved ductal distention with intravenous morphine administration, Radiographics, Vol. 24, May-June 2004