Geico (DOL after 10/1/12) MRI Brain without contrast prior authorization requirements (2026)
What Geico (DOL after 10/1/12) generally requires to approve MRI Brain without contrast (CPT 70551), for Auto No-Fault (NJ PIP) plans. Yes. Geico (DOL after 10/1/12) generally requires prior authorization for MRI Brain without contrast (CPT 70551).
Medical-necessity criteria Geico (DOL after 10/1/12) generally applies
Decision point review (DPR) required: MRI is on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so the determination to administer it is a decision point for ALL injuries, not just Care Path injuries (11:3-4.5(d)). Per 11:3-4.5(b)5, MRI use should conform to ACR Appropriateness Criteria and is not normally performed within 5 days of the insured event absent red flags (e.g., gross motor deficits, incontinence, acute nerve-root compression). No DPR or precertification applies to emergency care or within 10 days of the accident (11:3-4.7(b)) - medical necessity and causation still apply. Submit the DOBI Uniform APTP form with clinically supported findings from a personal examination; the carrier must respond within 3 business days (11:3-4.7(c)4), and under DOBI-approved plans treatment is deemed authorized until a determination issues if it fails to respond timely. Failure to request DPR where required risks a co-payment penalty of up to 50% of the eligible charge (11:3-4.4(e)); using a non-network facility where the plan has an approved voluntary network for MRI can add a penalty of up to 30% (11:3-4.4(g), 11:3-4.8(b)). Spine soft-tissue and disc-herniation injuries (identified injuries) also follow the DOBI Care Paths (11:3-4.6).
Commonly required documentation
- DOBI Uniform Attending Provider Treatment Plan (APTP) form ver. 16.03.10 (nj.gov/dobi/pipinfo/aptp_ver160310.pdf) - patient name/DOB, claim number, date of accident, ICD-10 codes, each CPT code with frequency/duration, provider signature
- clinically supported findings from a personal physical examination
- relevant progress notes and prior imaging/test results. Incomplete APTPs are denied as deficient.
How to submit
- Method: Fax APTP to ISG 866-257-2323 (phone 877-308-6599)
- Portal: ISG
- Typical turnaround: about 3 days
Sources & verification
NJ PIP (auto no-fault). Sources: N.J.A.C. 11:3-4 (eff. 10/16/2017), carrier DPRP: https://www.geico.com/public/pdf/statepages/nj/ep0304(07-21).pdf; OSSNJ no-fault pre-cert reference table (photographed 2026-06-25). Internal appeal required before PIP arbitration (11:3-4.7B): pre-service within 30 days of denial (decision due 14 days), post-service at least 45 days before ADR (decision due 30 days), on DOBI uniform appeal forms. IME: must be scheduled within 7 calendar days, same-discipline examiner, decision 3 business days after exam (11:3-4.7(e)). Statewide facts verified 2026-07-09. Vendor: ISG (Insight Service Group), Daphne AL, for dates of loss on/after 10/1/2012; OSSNJ table lists "Auto Injury Solutions" with the same fax. [NEEDS CLINICAL SPOT-CHECK] View the source policy. Last verified 2026-07-09.
Frequently asked questions
Does Geico (DOL after 10/1/12) require prior authorization for MRI Brain without contrast?
Yes. Geico (DOL after 10/1/12) generally requires prior authorization for MRI Brain without contrast (CPT 70551).
What does Geico (DOL after 10/1/12) require to approve MRI Brain without contrast?
Decision point review (DPR) required: MRI is on the N.J.A.C. 11:3-4.5(b) diagnostic-test list, so the determination to administer it is a decision point for ALL injuries, not just Care Path injuries (11:3-4.5(d)). Per 11:3-4.5(b)5, MRI use should conform to ACR Appropriateness Criteria and is not normally performed within 5 days of the insured event absent red flags (e.g., gross motor deficits, in… Always confirm against the current Geico (DOL after 10/1/12) policy.
How long does a Geico (DOL after 10/1/12) prior authorization take?
Geico (DOL after 10/1/12) typically decides MRI Brain without contrast requests in about 3 days. Timeframes vary; check the payer portal.
Submitting MRI Brain without contrast to Geico (DOL after 10/1/12)?
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.