eviCore MRI Lumbar Spine without and with contrast prior authorization requirements (2026)
What eviCore generally requires to approve MRI Lumbar Spine without and with contrast (CPT 72158), for Commercial plans. Yes. eviCore generally requires prior authorization for MRI Lumbar Spine without and with contrast (CPT 72158).
Medical-necessity criteria eviCore generally applies
Contrast-enhanced lumbar spine MRI (without and with gadolinium) is appropriate for: suspected or known spinal infection (discitis, vertebral osteomyelitis, epidural abscess); suspected spinal neoplasm or metastatic/leptomeningeal disease; or the post-operative lumbar spine (prior surgery at the level in question) to distinguish recurrent disc herniation from post-surgical scar. Contrast is NOT indicated for routine uncomplicated low back pain or first-presentation radiculopathy without red flags (non-contrast MRI is the appropriate study).
Source
Summarized from eviCore Spine Imaging Guidelines (eff. 2025-02-14) and ACR Appropriateness Criteria. Sources: and https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria View the source policy. Last verified 2026-06-13.
Frequently asked questions
Does eviCore require prior authorization for MRI Lumbar Spine without and with contrast?
Yes. eviCore generally requires prior authorization for MRI Lumbar Spine without and with contrast (CPT 72158).
What does eviCore require to approve MRI Lumbar Spine without and with contrast?
Contrast-enhanced lumbar spine MRI (without and with gadolinium) is appropriate for: suspected or known spinal infection (discitis, vertebral osteomyelitis, epidural abscess); suspected spinal neoplasm or metastatic/leptomeningeal disease; or the post-operative lumbar spine (prior surgery at the level in question) to distinguish recurrent disc herniation from post-surgical scar. Contrast is NOT in… 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 Lumbar Spine 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.