Anthem/Elevance Health MRI Upper Extremity Joint without contrast prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve MRI Upper Extremity Joint without contrast (CPT 73221), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
Medical-necessity criteria Anthem/Elevance Health generally applies
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when rotator cuff or other internal derangement is suspected and initial radiographs are normal/inconclusive. Not routine for initial atraumatic shoulder pain; obtain radiographs first.
Situations to verify before submitting
Anthem/Elevance Health may not cover MRI Upper Extremity Joint without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine initial evaluation of atraumatic shoulder pain with MRI before radiographs (radiographs are the appropriate first study per ACR criteria)","source":"ACR Appropriateness Criteria: Shoulder Pain-Atraumatic"}
Source
Advanced imaging PA for Anthem/Elevance is managed by Carelon. Criteria summarized from ACR Appropriateness Criteria Atraumatic/Chronic Shoulder Pain. Source: jacr.org; Carelon radiology program. Last verified 2026-06-12.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for MRI Upper Extremity Joint without contrast?
Yes. Anthem/Elevance Health generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
What does Anthem/Elevance Health require to approve MRI Upper Extremity Joint without contrast?
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when rotator cuff or other internal derangement is suspected and initial radiographs are normal/inconclusive. Not routine for initial atraumatic shoulder pain; 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 Upper 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.