Anthem/Elevance Health MRI Lower Extremity Joint without contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve MRI Lower Extremity Joint without contrast (CPT 73721), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for MRI Lower Extremity Joint without contrast (CPT 73721).
Medical-necessity criteria Anthem/Elevance Health generally applies
Knee MRI without contrast is appropriate (per ACR Appropriateness Criteria for Chronic Knee Pain) when initial radiographs are normal/effusion, show OCD/loose bodies or prior cartilage/meniscal repair, or internal derangement is suspected. Obtain radiographs first.
Situations to verify before submitting
Anthem/Elevance Health may not cover MRI Lower Extremity Joint without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Chronic knee pain imaged with MRI before obtaining initial knee radiographs (radiographs are the appropriate first study per ACR criteria)","source":"ACR Appropriateness Criteria: Chronic Knee Pain"}
Source
Advanced imaging PA for Anthem/Elevance is managed by Carelon. Criteria summarized from ACR Appropriateness Criteria Chronic Knee Pain. Source: jacr.org; Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for MRI Lower Extremity Joint without contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for MRI Lower Extremity Joint without contrast (CPT 73721).
What does Anthem/Elevance Health require to approve MRI Lower Extremity Joint without contrast?
Knee MRI without contrast is appropriate (per ACR Appropriateness Criteria for Chronic Knee Pain) when initial radiographs are normal/effusion, show OCD/loose bodies or prior cartilage/meniscal repair, or internal derangement is suspected. Obtain radiographs first. 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 Lower Extremity Joint 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.