Anthem/Elevance Health CT Abdomen and Pelvis with contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve CT Abdomen and Pelvis with contrast (CPT 74177), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for CT Abdomen and Pelvis with contrast (CPT 74177).
Medical-necessity criteria Anthem/Elevance Health generally applies
CT of the abdomen and pelvis with IV contrast is appropriate (per ACR Appropriateness Criteria for Acute Nonlocalized Abdominal Pain) as a first-line study for nonlocalized abdominal pain, especially with fever or suspected infectious/inflammatory/neoplastic/vascular pathology. Document the findings and prior imaging.
Situations to verify before submitting
Anthem/Elevance Health may not cover CT Abdomen and Pelvis with contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine or duplicate abdominal CT when a recent equivalent study already addresses the clinical question, or first-line CT in pregnancy where ultrasound or MRI is preferred (per ACR criteria)","source":"ACR Appropriateness Criteria: Acute Nonlocalized Abdominal Pain"}
Source
Outpatient advanced imaging PA for Anthem/Elevance is managed by Carelon. Criteria summarized from ACR Appropriateness Criteria Acute Nonlocalized Abdominal Pain. Source: jacr.org; Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for CT Abdomen and Pelvis with contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for CT Abdomen and Pelvis with contrast (CPT 74177).
What does Anthem/Elevance Health require to approve CT Abdomen and Pelvis with contrast?
CT of the abdomen and pelvis with IV contrast is appropriate (per ACR Appropriateness Criteria for Acute Nonlocalized Abdominal Pain) as a first-line study for nonlocalized abdominal pain, especially with fever or suspected infectious/inflammatory/neoplastic/vascular pathology. Document the findings and prior imaging. Always confirm against the current Anthem/Elevance Health policy.
How long does a Anthem/Elevance Health prior authorization take?
Turnaround varies by plan and submission method. Check the Anthem/Elevance Health portal for current timeframes.
Submitting CT Abdomen and Pelvis with contrast to Anthem/Elevance Health?
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.