eviCore CT Head/Brain without contrast prior authorization requirements (2026)
What eviCore generally requires to approve CT Head/Brain without contrast (CPT 70450), for Commercial plans. Yes. eviCore generally requires prior authorization for CT Head/Brain without contrast (CPT 70450).
Medical-necessity criteria eviCore generally applies
Non-contrast head CT is appropriate for: acute head trauma (per ACR Head Trauma criteria, including mild TBI meeting a validated clinical decision rule); suspected acute stroke or intracranial hemorrhage; acute neurological change or new focal deficit; and headache with red flags (thunderclap onset, focal neurologic findings, immunocompromise, or known malignancy). Uncomplicated chronic or primary headache without red flags does not meet criteria.
Sources & verification
- BindingPayer medical policy.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 2026-06-13.
Frequently asked questions
Does eviCore require prior authorization for CT Head/Brain without contrast?
Yes. eviCore generally requires prior authorization for CT Head/Brain without contrast (CPT 70450).
What does eviCore require to approve CT Head/Brain without contrast?
Non-contrast head CT is appropriate for: acute head trauma (per ACR Head Trauma criteria, including mild TBI meeting a validated clinical decision rule); suspected acute stroke or intracranial hemorrhage; acute neurological change or new focal deficit; and headache with red flags (thunderclap onset, focal neurologic findings, immunocompromise, or known malignancy). Uncomplicated chronic or primary… 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 Head/Brain 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.