eviCore CT Abdomen and Pelvis without contrast prior authorization requirements (2026)
What eviCore generally requires to approve CT Abdomen and Pelvis without contrast (CPT 74176), for Commercial plans. Yes. eviCore generally requires prior authorization for CT Abdomen and Pelvis without contrast (CPT 74176).
Medical-necessity criteria eviCore generally applies
Non-contrast abdomen/pelvis CT is appropriate for: suspected acute renal or ureteral colic (urolithiasis; non-contrast CT KUB is the study of choice); follow-up of known renal/ureteral stones; and abdominal/pelvic evaluation when iodinated contrast is contraindicated. Most other abdominal/pelvic indications (infection, mass, inflammatory bowel disease) are evaluated with contrast.
Source
Summarized from ACR Appropriateness Criteria and eviCore abdomen imaging guidelines (suspected renal/ureteral stones). Sources: and https://www.evicore.com/provider/clinical-guidelines View the source policy. Last verified 2026-06-13.
Frequently asked questions
Does eviCore require prior authorization for CT Abdomen and Pelvis without contrast?
Yes. eviCore generally requires prior authorization for CT Abdomen and Pelvis without contrast (CPT 74176).
What does eviCore require to approve CT Abdomen and Pelvis without contrast?
Non-contrast abdomen/pelvis CT is appropriate for: suspected acute renal or ureteral colic (urolithiasis; non-contrast CT KUB is the study of choice); follow-up of known renal/ureteral stones; and abdominal/pelvic evaluation when iodinated contrast is contraindicated. Most other abdominal/pelvic indications (infection, mass, inflammatory bowel disease) are evaluated with contrast. Always confirm against the current eviCore policy.
How long does a eviCore prior authorization take?
Turnaround varies by plan and submission method. Check the eviCore portal for current timeframes.
Submitting CT Abdomen and Pelvis without contrast to eviCore?
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.