Braven Health CT Lumbar Spine without contrast prior authorization requirements (2026)
What Braven Health generally requires to approve CT Lumbar Spine without contrast (CPT 72131), for Medicare Advantage plans. Yes. Braven Health generally requires prior authorization for CT Lumbar Spine without contrast (CPT 72131).
Medical-necessity criteria Braven Health generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Braven Health (Horizon-affiliated NJ Medicare Advantage) uses eviCore by Evernorth (via Horizon) to review Advanced Imaging Services (MRI/MRA, CT/CTA), including spine. Criteria follow eviCore Spine Imaging Guidelines (failed ~6-week conservative trial for uncomplicated pain; red-flag bypass).
How to submit
- Method: eviCore (via Horizon)
Sources & verification
- BindingSource — Submitting First Level UM Appeals for Braven Health Members (eviCore radiology imaging).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 Braven Health require prior authorization for CT Lumbar Spine without contrast?
Yes. Braven Health generally requires prior authorization for CT Lumbar Spine without contrast (CPT 72131).
What does Braven Health require to approve CT Lumbar Spine without contrast?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Braven Health (Horizon-affiliated NJ Medicare Advantage) uses eviCore by Evernorth (via Horizon) to review Advanced Imaging Services (MRI/MRA, CT/CTA), including spine. Criteria follow eviCore Spine Imaging Guidelines (failed ~6-week conservative trial for uncomplicated pain; red-flag bypass). Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting CT Lumbar Spine without contrast to Braven 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.