Anthem/Elevance Health CTA Chest (e.g., pulmonary embolism) prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve CTA Chest (e.g., pulmonary embolism) (CPT 71275), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for CTA Chest (e.g., pulmonary embolism) (CPT 71275).
Medical-necessity criteria Anthem/Elevance Health generally applies
CT angiography of the chest is appropriate (per ACR Appropriateness Criteria for Acute Chest Pain-Suspected Pulmonary Embolism) as first-line imaging when pretest probability is high, or when D-dimer is positive at low/intermediate pretest probability. Document the pretest-probability score and D-dimer.
Situations to verify before submitting
Anthem/Elevance Health may not cover CTA Chest (e.g., pulmonary embolism) in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Low or intermediate pretest probability with a NEGATIVE D-dimer (PE can be safely excluded without imaging per ACR criteria)","source":"ACR Appropriateness Criteria: Acute Chest Pain-Suspected Pulmonary Embolism"}
Source
Advanced imaging PA for Anthem/Elevance is managed by Carelon. Criteria summarized from ACR Appropriateness Criteria Acute Chest Pain-Suspected Pulmonary Embolism. Source: jacr.org; Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for CTA Chest (e.g., pulmonary embolism)?
Yes. Anthem/Elevance Health generally requires prior authorization for CTA Chest (e.g., pulmonary embolism) (CPT 71275).
What does Anthem/Elevance Health require to approve CTA Chest (e.g., pulmonary embolism)?
CT angiography of the chest is appropriate (per ACR Appropriateness Criteria for Acute Chest Pain-Suspected Pulmonary Embolism) as first-line imaging when pretest probability is high, or when D-dimer is positive at low/intermediate pretest probability. Document the pretest-probability score and D-dimer. 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 CTA Chest (e.g., pulmonary embolism) 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.