Clover Health CT Lumbar Spine without contrast prior authorization requirements (2026)
What Clover Health generally requires to approve CT Lumbar Spine without contrast (CPT 72131), for Medicare Advantage plans. Yes. Clover Health generally requires prior authorization for CT Lumbar Spine without contrast (CPT 72131).
Medical-necessity criteria Clover Health generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required for advanced imaging (CT, CTA, MRI, MRA, PET). For lumbar spine MRI, Clover's PA list requires documentation of the reason for the procedure, chief complaint, and conservative measures tried/failed with duration.
Sources & verification
- BindingSource — Clover Health Prior Authorization List 2024 · effective 2024-01-01.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 Clover Health require prior authorization for CT Lumbar Spine without contrast?
Yes. Clover Health generally requires prior authorization for CT Lumbar Spine without contrast (CPT 72131).
What does Clover Health require to approve CT Lumbar Spine without contrast?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required for advanced imaging (CT, CTA, MRI, MRA, PET). For lumbar spine MRI, Clover's PA list requires documentation of the reason for the procedure, chief complaint, and conservative measures tried/failed with duration. Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting CT Lumbar Spine without contrast to Clover 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.