Aetna MRI Upper Extremity Joint without contrast prior authorization requirements (2026)
What Aetna generally requires to approve MRI Upper Extremity Joint without contrast (CPT 73221), for Commercial plans. Yes. Aetna generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
Medical-necessity criteria Aetna generally applies
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when rotator cuff or other internal derangement is suspected and initial radiographs are normal/inconclusive. Not routine for initial atraumatic shoulder pain; obtain radiographs first.
Situations to verify before submitting
Aetna may not cover MRI Upper Extremity Joint without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine initial evaluation of atraumatic shoulder pain with MRI before radiographs (radiographs are the appropriate first study per ACR criteria)","source":"ACR Appropriateness Criteria: Shoulder Pain-Atraumatic"}
Source
Advanced imaging PA for Aetna is managed by eviCore. Criteria summarized from ACR Appropriateness Criteria Atraumatic/Chronic Shoulder Pain. Source: jacr.org; eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Aetna require prior authorization for MRI Upper Extremity Joint without contrast?
Yes. Aetna generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
What does Aetna require to approve MRI Upper Extremity Joint without contrast?
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when rotator cuff or other internal derangement is suspected and initial radiographs are normal/inconclusive. Not routine for initial atraumatic shoulder pain; obtain radiographs first. 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 Upper Extremity Joint 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.