eviCore MRI Brain without and with contrast prior authorization requirements (2026)
What eviCore generally requires to approve MRI Brain without and with contrast (CPT 70553), for Commercial plans. Yes. eviCore generally requires prior authorization for MRI Brain without and with contrast (CPT 70553).
Medical-necessity criteria eviCore generally applies
Contrast-enhanced brain MRI (without and with gadolinium) is appropriate for: suspected intracranial neoplasm or metastatic disease; intracranial infection (abscess, encephalitis, meningitis); known or suspected multiple sclerosis and its follow-up; post-operative or post-treatment evaluation; and suspected pituitary/sellar lesion (dedicated protocol). Uncomplicated headache without red flags does not meet criteria for contrast brain MRI.
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 MRI Brain without and with contrast?
Yes. eviCore generally requires prior authorization for MRI Brain without and with contrast (CPT 70553).
What does eviCore require to approve MRI Brain without and with contrast?
Contrast-enhanced brain MRI (without and with gadolinium) is appropriate for: suspected intracranial neoplasm or metastatic disease; intracranial infection (abscess, encephalitis, meningitis); known or suspected multiple sclerosis and its follow-up; post-operative or post-treatment evaluation; and suspected pituitary/sellar lesion (dedicated protocol). Uncomplicated headache without red flags does… 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 MRI Brain without and with 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.