Clover Health MRI Cervical Spine without and with contrast prior authorization requirements (2026)
What Clover Health generally requires to approve MRI Cervical Spine without and with contrast (CPT 72156), for Medicare Advantage plans. Yes. Clover Health generally requires prior authorization for MRI Cervical Spine without and with contrast (CPT 72156).
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 MRI Cervical Spine without and with contrast?
Yes. Clover Health generally requires prior authorization for MRI Cervical Spine without and with contrast (CPT 72156).
What does Clover Health require to approve MRI Cervical Spine without and with 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 MRI Cervical Spine without and with 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.