Aetna MRI Lumbar Spine without contrast prior authorization requirements (2026)
What Aetna generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for Commercial plans. Yes. Aetna generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria Aetna generally applies
Lumbar spine MRI is appropriate (per ACR Appropriateness Criteria for Low Back Pain) when persistent or progressive symptoms remain after at least 6 weeks of conservative management in a surgical/interventional candidate, when radiculopathy has persisted more than 6 weeks despite conservative care, or when red flags (cauda equina, malignancy, infection, severe/progressive neurologic deficit) are present. Document conservative-care type/duration and red-flag findings.
Situations to verify before submitting
Aetna may not cover MRI Lumbar Spine without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine, uncomplicated acute low back pain of less than 6 weeks duration without red flags or neurologic deficit (imaging not indicated per ACR criteria)","source":"ACR Appropriateness Criteria: Low Back Pain (2021 Update)"}
Source
Advanced imaging PA for Aetna is managed by eviCore. Criteria summarized from the ACR Appropriateness Criteria for Low Back Pain (2021). Source: ACR Appropriateness Criteria Low Back Pain 2021 Update (jacr.org); eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Aetna require prior authorization for MRI Lumbar Spine without contrast?
Yes. Aetna generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does Aetna require to approve MRI Lumbar Spine without contrast?
Lumbar spine MRI is appropriate (per ACR Appropriateness Criteria for Low Back Pain) when persistent or progressive symptoms remain after at least 6 weeks of conservative management in a surgical/interventional candidate, when radiculopathy has persisted more than 6 weeks despite conservative care, or when red flags (cauda equina, malignancy, infection, severe/progressive neurologic deficit) are p… 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 Lumbar 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.