Commonly Over-utilized Procedures (COPs)



Back Pain Imaging

Don't do imaging for low back pain within the first six weeks, unless red flags are present.

Cervical Cancer Screening

Don't perform cervical cancer screening in older women (over 65 years)

IgG/IgE Testing

Don't routinely do diagnostic testing in patients with chronic urticaria.

Digoxin CHF

Don't perform routine monitoring of digoxin in patients with congestive heart failure.

Drain/Inject Joint/Bursa


Brain CT/MRI Headaches

Don't do imaging for uncomplicated headache.

Asthma w/out Spirometry

Don't diagnose or manage asthma without spirometry.

Hysterectomy benign

Don't perform hysterectomy for benign disease.

EEG Headaches

Don't perform electroencephalography (EEG) for headaches.

DXA Bone Density

Don't use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.

Brain CT/MRI Syncopes

In the evaluation of simple syncope and a normal neurological examination, don't obtain brain imaging studies (CT or MRI).

Annual EKGs

Don't order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.

Pap Smear

Don't do pap smear for females < 21 or had hysterectomy procedures without a malignant neoplasm diagnosis.

Vitamin D 25 Hydroxy

Don't perform population based screening for 25-OH-Vitamin D deficiency.

Benign Prostatic Hyperplasia

Don’t order creatinine or upper-tract imaging for patients with benign prostatic hyperplasia (BPH).

Pre-existing cervical, thoracic, lumber disease

Don’t use electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of axial lumbar, thoracic or cervical spine pain.

PSA Screening

Don't perform prostate cancer screening in men over 75 years.

Sinus CT

Don't order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.