Fallon Health MRI Lumbar Spine without contrast prior authorization requirements (2026)
What Fallon Health generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for Commercial, MassHealth ACO (Fallon 365 Care), Medicare plans. Yes. Fallon Health generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria Fallon Health generally applies
Prior authorization is required for high-tech outpatient diagnostic imaging (CT, PET, MRI, and nuclear cardiac imaging) for all members; managed by eviCore. Reviewed against eviCore radiology clinical guidelines.
Related procedure codes
Codes often billed alongside MRI Lumbar Spine without contrast: 72148. Verify the correct codes for your documentation.
Commonly required documentation
- Clinical exam findings and conservative-care documentation supporting the imaging request.
How to submit
- Method: eviCore
- Portal: eviCore healthcare
Source
Source: Fallon Referral and Prior Authorization Procedures + authorization-requirements policies page. Confirm CPT 72148 on the eviCore Fallon radiology guideline. Last verified 2026-06-17.
Frequently asked questions
Does Fallon Health require prior authorization for MRI Lumbar Spine without contrast?
Yes. Fallon Health generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does Fallon Health require to approve MRI Lumbar Spine without contrast?
Prior authorization is required for high-tech outpatient diagnostic imaging (CT, PET, MRI, and nuclear cardiac imaging) for all members; managed by eviCore. Reviewed against eviCore radiology clinical guidelines. Always confirm against the current Fallon Health policy.
How long does a Fallon Health prior authorization take?
Turnaround varies by plan and submission method. Check the Fallon Health portal for current timeframes.
Submitting MRI Lumbar Spine without contrast to Fallon Health?
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.