Use of Imaging Studies for Low Back Pain (LBP)

Assesses adults 18–75 years of age with a principal diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis (a higher score indicates better performance).

Why It Matters?

About 2.63 million ER visits in the U.S. each year are for low back pain-related disorders.1 75%–85% of Americans will have low back pain at some time in their lives.2 In any 3-month period, about 25% of Americans will face at least 1 day of back pain.3 Evidence shows that when there is no “red flag” (e.g., a broken bone, a serious disease), routine imaging (X-ray, MRI, CT scan) for low back pain does not always improve outcomes, and could expose an individual to unneeded harms like radiation, and possibly to unnecessary treatment.4 It is critical to reduce imaging when there are no red flags so treatments that are not effective, and that may result in extra costs, are kept to a minimum.5

Results – National Averages

Imaging Studies for Low Back Pain

Measure YearCommercial HMOCommerial PPOMedicaid HMO

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via for analysis that accounts for trend breaks.


  1. Friedman, B.W., M. Chilstrom, P.E. Bijur, & E.J. Gallagher. 2010. “Diagnostic Testing and Treatment of Low Back Pain in US Emergency Departments. A national Perspective.” Spine 35(24), E1406–E1411.
  2. American Association of Neurological Surgeons. 2020. Low Back Pain.
  3. Deyo, R.A., S.K. Mirza, B.I. Martin. 2006. “Back Pain Prevalence and Visit Rates: Estimates from U.S. National Surveys, 2002.” Spine 31(23):2724–7.
  4. Downie, A., et al. 2013. “Red Flags to Screen for Malignancy and Fracture in Patients with Low Back Pain: Systematic Review.” BMJ 347:f7095. doi: 10.1136/bmj.f7095
  5. Owens, D.K., A. Qaseem, R. Chou, P. Shekelle, & Clinical Guidelines Committee of the American College of Physicians. 2011. “High Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate Benefits, Harms, and Costs of Medical Interventions.” Ann Intern Med. 154:174–80. doi: 10.7326/0003-4819-154-3-201102010-00007
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