Aetna CT Cervical Spine without contrast prior authorization requirements (2026)
What Aetna generally requires to approve CT Cervical Spine without contrast (CPT 72125), for Commercial plans. Yes. Aetna generally requires prior authorization for CT Cervical Spine without contrast (CPT 72125).
Medical-necessity criteria Aetna generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Aetna precertifies advanced spine imaging through eviCore. Per Aetna CPB 0236, MRI/CT of the spine is considered medically necessary for spinal stenosis, suspected cord/cauda equina compression, myelopathy, suspected malignancy/infection/fracture, or persistent back/neck pain with radiculopathy not improving after 6 weeks of conservative therapy (4 weeks for spondylolisthesis). Conservative therapy = activity modification, analgesics, NSAIDs, muscle relaxants. Progressive/red-flag neurologic deficits are exempt from the waiting period.
How to submit
- Method: eviCore (CareCore National portal)
Sources & verification
- BindingSource — MRI and CT of the Spine — Clinical Policy Bulletin (CPB 0236).View
- BindingSource — EviCore Spine Imaging Guidelines (generic) (V1.1.2025) · effective 2025-02-14.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-28.
Frequently asked questions
Does Aetna require prior authorization for CT Cervical Spine without contrast?
Yes. Aetna generally requires prior authorization for CT Cervical Spine without contrast (CPT 72125).
What does Aetna require to approve CT Cervical Spine without contrast?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Aetna precertifies advanced spine imaging through eviCore. Per Aetna CPB 0236, MRI/CT of the spine is considered medically necessary for spinal stenosis, suspected cord/cauda equina compression, myelopathy, suspected malignancy/infection/fracture, or persistent back/neck pain with radiculopathy not improving after 6 weeks of conservative th… Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting CT Cervical Spine without contrast to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.