Mass General Brigham Health Plan MRI Lumbar Spine without contrast prior authorization requirements (2026)
What Mass General Brigham Health Plan generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for Commercial: PA required; MGB ACO/MassHealth: not required; MGB ASO tier-1: not required plans. Yes. Mass General Brigham Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria Mass General Brigham Health Plan generally applies
For Commercial members, prior authorization is required for outpatient non-emergent CT, MRI, and PET studies, reviewed through Mass General Brigham Health Plan. Prior authorization is NOT required for Mass General Brigham ACO/MassHealth members, nor for MGB ASO members when services are provided by MGB tier-1 (preferred) providers.
Related procedure codes
Codes often billed alongside MRI Lumbar Spine without contrast: 72148, 72149, 72158. 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: Mass General Brigham Health Plan provider portal
- Portal: MGBHP Provider Portal
Source
Source: MGBHP Prior Authorization, Notification, and Referral Guidelines. As of 2021 high-tech imaging PA is handled by the plan (no longer eviCore). Last verified 2026-06-17.
Frequently asked questions
Does Mass General Brigham Health Plan require prior authorization for MRI Lumbar Spine without contrast?
Yes. Mass General Brigham Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does Mass General Brigham Health Plan require to approve MRI Lumbar Spine without contrast?
For Commercial members, prior authorization is required for outpatient non-emergent CT, MRI, and PET studies, reviewed through Mass General Brigham Health Plan. Prior authorization is NOT required for Mass General Brigham ACO/MassHealth members, nor for MGB ASO members when services are provided by MGB tier-1 (preferred) providers. Always confirm against the current Mass General Brigham Health Plan policy.
How long does a Mass General Brigham Health Plan prior authorization take?
Turnaround varies by plan and submission method. Check the Mass General Brigham Health Plan portal for current timeframes.
Submitting MRI Lumbar Spine without contrast to Mass General Brigham Health Plan?
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.