Aetna MRI Brain without contrast prior authorization requirements (2026)
What Aetna generally requires to approve MRI Brain without contrast (CPT 70551), for Commercial plans. Yes. Aetna generally requires prior authorization for MRI Brain without contrast (CPT 70551).
Medical-necessity criteria Aetna generally applies
Brain MRI is appropriate (per ACR Appropriateness Criteria for Headache) for new or progressively worsening headache with red flags (subacute trauma; exertional/sexual/positional trigger; neurologic deficit; known or suspected cancer; immunocompromised; age 50+; thunderclap onset). Not indicated for uncomplicated migraine or tension-type headache with a normal neurologic examination.
Situations to verify before submitting
Aetna may not cover MRI Brain without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Uncomplicated migraine or tension-type headache with a normal neurologic examination (neuroimaging not indicated per ACR criteria)","source":"ACR Appropriateness Criteria: Headache"}
Source
Advanced imaging PA for Aetna is managed by eviCore. Criteria summarized from ACR Appropriateness Criteria Headache. Source: jacr.org; eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Aetna require prior authorization for MRI Brain without contrast?
Yes. Aetna generally requires prior authorization for MRI Brain without contrast (CPT 70551).
What does Aetna require to approve MRI Brain without contrast?
Brain MRI is appropriate (per ACR Appropriateness Criteria for Headache) for new or progressively worsening headache with red flags (subacute trauma; exertional/sexual/positional trigger; neurologic deficit; known or suspected cancer; immunocompromised; age 50+; thunderclap onset). Not indicated for uncomplicated migraine or tension-type headache with a normal neurologic examination. 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 MRI Brain 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.