Anthem/Elevance Health MRI Thoracic Spine without contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve MRI Thoracic Spine without contrast (CPT 72146), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for MRI Thoracic Spine without contrast (CPT 72146).
Medical-necessity criteria Anthem/Elevance Health generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Anthem/Elevance delegates advanced spine imaging to Carelon Medical Benefits Management. For neck/mid-back/low-back pain WITHOUT neurologic findings, advanced imaging requires at least 6 weeks of conservative management consisting of physical therapy PLUS at least one additional modality (e.g., anti-inflammatory medication, epidural injection, acupuncture). Red-flag exceptions allow immediate imaging: new neurologic exam findings suggesting nerve-root or cord compression, and suspected acute cauda equina syndrome. MRI preferred; CT when MRI cannot be performed or is nondiagnostic.
How to submit
- Method: Carelon (ProviderPortal)
Sources & verification
- BindingSource — Clinical Appropriateness Guidelines: Imaging of the Spine (RBM05-1125.1) · effective 2025-11-15.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-28.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for MRI Thoracic Spine without contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for MRI Thoracic Spine without contrast (CPT 72146).
What does Anthem/Elevance Health require to approve MRI Thoracic Spine without contrast?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Anthem/Elevance delegates advanced spine imaging to Carelon Medical Benefits Management. For neck/mid-back/low-back pain WITHOUT neurologic findings, advanced imaging requires at least 6 weeks of conservative management consisting of physical therapy PLUS at least one additional modality (e.g., anti-inflammatory medication, epidural injecti… 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 Thoracic 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.