Anthem/Elevance Health MRI Lumbar Spine without contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria Anthem/Elevance Health generally applies
Lumbar spine MRI is appropriate (per ACR Appropriateness Criteria for Low Back Pain) after at least 6 weeks of conservative management with persistent/progressive symptoms in a surgical/interventional candidate, for radiculopathy persisting more than 6 weeks despite conservative care, or when red flags (cauda equina, malignancy, infection, severe/progressive neurologic deficit) are present. Document the conservative-care trial and red-flag findings.
Situations to verify before submitting
Anthem/Elevance Health may not cover MRI Lumbar Spine without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine, uncomplicated acute low back pain of less than 6 weeks duration without red flags or neurologic deficit (imaging not indicated per ACR criteria)","source":"ACR Appropriateness Criteria: Low Back Pain (2021 Update)"}
Source
Advanced imaging PA for Anthem/Elevance is managed by Carelon Medical Benefits Management. Criteria summarized from the ACR Appropriateness Criteria for Low Back Pain (2021). Source: ACR Appropriateness Criteria Low Back Pain 2021 Update (jacr.org); Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for MRI Lumbar Spine without contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does Anthem/Elevance Health require to approve MRI Lumbar Spine without contrast?
Lumbar spine MRI is appropriate (per ACR Appropriateness Criteria for Low Back Pain) after at least 6 weeks of conservative management with persistent/progressive symptoms in a surgical/interventional candidate, for radiculopathy persisting more than 6 weeks despite conservative care, or when red flags (cauda equina, malignancy, infection, severe/progressive neurologic deficit) are present. Docume… 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 Lumbar Spine 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.