Horizon BCBS NJ MRI Thoracic Spine with contrast prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve MRI Thoracic Spine with contrast (CPT 72147), for PPO plans. Yes. Horizon BCBS NJ generally requires prior authorization for MRI Thoracic Spine with contrast (CPT 72147).
Medical-necessity criteria Horizon BCBS NJ generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Horizon BCBS NJ partners with eviCore by Evernorth for medical-necessity review of Advanced Imaging Services (CT/CTA, MRI/MRA), including spine. Criteria follow eviCore's Spine Imaging Guidelines: an in-person evaluation plus a documented failed ~6-week conservative trial for uncomplicated pain, with red-flag bypass (motor weakness, cauda equina, cancer, fracture, infection, severe radicular pain).
How to submit
- Method: portal
Sources & verification
- BindingSource — eviCore healthcare — Radiology/Imaging Services.View
- BindingSource — Radiology Imaging Program Questions and Answers.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 2026-06-28.
Frequently asked questions
Does Horizon BCBS NJ require prior authorization for MRI Thoracic Spine with contrast?
Yes. Horizon BCBS NJ generally requires prior authorization for MRI Thoracic Spine with contrast (CPT 72147).
What does Horizon BCBS NJ require to approve MRI Thoracic Spine with contrast?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization required; Horizon BCBS NJ partners with eviCore by Evernorth for medical-necessity review of Advanced Imaging Services (CT/CTA, MRI/MRA), including spine. Criteria follow eviCore's Spine Imaging Guidelines: an in-person evaluation plus a documented failed ~6-week conservative trial for uncomplicated pain, with red-flag bypass (motor weakness, cauda e… Always confirm against the current Horizon BCBS NJ policy.
How long does a Horizon BCBS NJ prior authorization take?
Turnaround varies by plan and submission method. Check the Horizon BCBS NJ portal for current timeframes.
Submitting MRI Thoracic Spine with contrast to Horizon BCBS NJ?
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.