MRE and MASH Therapies

When you're unsure if new MASH therapies are right for you, there's MRE.

Why MRE Matters in the Era of MASH Treatments

The recent approvals of Rezdiffra™ (resmetirom) and Wegovy™ (semaglutide) mark a major milestone in the treatment of MASH (metabolic dysfunction-associated steatohepatitis), but it also presents a challenge: how do we reliably identify the right patients—those with moderate to advanced fibrosis (F2–F3)—without resorting to liver biopsy? As physicians and patients look for alternatives to invasive diagnostics, Magnetic Resonance Elastography (MRE) has emerged as the gold standard in noninvasive liver fibrosis assessment.

Ensuring the Right Test for the Right Patient

When it comes to understanding your liver health, getting the right test truly matters. While many doctors use a tool called FibroScan® (also known as VCTE) to check for liver scarring, recent studies have shown that this test can give false positives, especially in patients with a higher body mass index (BMI). That means some people are mistakenly told they may have serious liver disease—leading to unnecessary stress, extra testing, and even treatments they may not need. Beyond the added costs, these false alarms can cause real anxiety, confusion, and fear about your health. That’s why more doctors are turning to MR Elastography (MRE)—an advanced imaging test that provides a clearer, more accurate picture of your liver regardless of BMI. It helps ensure you and your care team make the right decisions based on reliable information. Because you deserve clarity, not confusion.

BMI ≤ 20

BMI ≥ 25

BMI ≥ 30

False positive rates with ultrasound increase with BMI

Tips and Best Practices

Ready to request an MRE exam? Great!

Keep in mind that many MRI centers default to full abdominal MRI (with and without contrast), but this is longer, more costly, and unnecessary in most MASLD/MASH cases.

For patients who need fibrosis staging only, clinicians should request the shorter, standalone MRE exam using CPT code 76391.

When to Use Standalone MRE (CPT 76391)

Patient has BMI >30 or VCTE failure
Suspected MASLD/MASH with need for fibrosis staging
No suspicion of hepatocellular carcinoma (HCC)
Monitoring fibrosis progression or drug response

How to Order the Right Exam

Clearly write “MRE only – CPT code 76391” on the imaging order
Check or circle the box that indicates elastography only, not full MRI abdomen
If assessing liver fat too, write “Add PDFF to short exam (CPT 76391)”
Avoid “MRI abdomen with and without contrast” unless HCC or masses are suspected
Confirm the radiology center understands the order as a non-contrast, targeted exam

Tips for Clinicians

Use MRE for reliable fibrosis staging when VCTE is suboptimal
Educate radiology schedulers to prevent unnecessary full MRI protocols
This keeps imaging quick, affordable (~$200 CMS global), and patient-friendly

Coverage

When it comes to getting your liver tested, it’s important to know what your insurance will actually cover. All major insurers recognize MR Elastography (MRE) as a valid, reliable way to assess liver fibrosis. In fact, some insurers will only accept MRE for treatment approval, including access to breakthrough medications like Rezdiffra™ and Wegovy™. Tests like FibroScan® (VCTE), while commonly used, may not be covered by your insurance and could leave you with unexpected out-of-pocket charges for a test that may not even support treatment authorization. That’s why both patients and providers need to be informed: choosing the right test isn’t just about accuracy—it’s also about avoiding unnecessary costs and delays.

MRE or VCTE