eviCore CT Chest without contrast prior authorization requirements (2026)
What eviCore generally requires to approve CT Chest without contrast (CPT 71250), for Commercial plans. Yes. eviCore generally requires prior authorization for CT Chest without contrast (CPT 71250).
Medical-necessity criteria eviCore generally applies
Non-contrast chest CT is appropriate for: detection and follow-up of pulmonary nodules; evaluation of suspected interstitial or diffuse parenchymal lung disease; and chest evaluation when iodinated contrast is contraindicated. Suspected pulmonary embolism, vascular pathology, or a mediastinal/hilar mass is evaluated with contrast rather than this study.
Source
Summarized from ACR Appropriateness Criteria and eviCore chest imaging guidelines. 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 Chest without contrast?
Yes. eviCore generally requires prior authorization for CT Chest without contrast (CPT 71250).
What does eviCore require to approve CT Chest without contrast?
Non-contrast chest CT is appropriate for: detection and follow-up of pulmonary nodules; evaluation of suspected interstitial or diffuse parenchymal lung disease; and chest evaluation when iodinated contrast is contraindicated. Suspected pulmonary embolism, vascular pathology, or a mediastinal/hilar mass is evaluated with contrast rather than this study. 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 Chest 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.