Anthem/Elevance Health MRI Brain without contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve MRI Brain without contrast (CPT 70551), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for MRI Brain without contrast (CPT 70551).
Medical-necessity criteria Anthem/Elevance Health 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
Anthem/Elevance Health 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 Anthem/Elevance is managed by Carelon. Criteria summarized from ACR Appropriateness Criteria Headache. Source: jacr.org; Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for MRI Brain without contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for MRI Brain without contrast (CPT 70551).
What does Anthem/Elevance Health 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 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 MRI Brain without 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.