Medicare (CMS LCD/NCD) MRI Brain without contrast prior authorization requirements (2026)
What Medicare (CMS LCD/NCD) generally requires to approve MRI Brain without contrast (CPT 70551), for Medicare plans. Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for MRI Brain without contrast (CPT 70551). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
Medical-necessity criteria Medicare (CMS LCD/NCD) generally applies
Traditional Medicare (fee-for-service) generally does NOT require prior authorization for outpatient MRI/CT; the study is covered under Part B when medically necessary (the beneficiary pays the Part B coinsurance after the deductible). The CMS Appropriate Use Criteria (AUC) program that would have required consulting a qualified clinical decision support mechanism is PAUSED and its regulations (42 CFR 414.94) were rescinded effective 2024. Medicare Advantage plans set their own prior-authorization rules and may require PA through a benefit manager, subject to the CMS-0057-F decision timelines (7 calendar days standard / 72 hours expedited).
Source
Source: CMS Appropriate Use Criteria Program (paused; 42 CFR 414.94 rescinded effective 2024, CMS MM13485) and Medicare Part B diagnostic-imaging coverage. Traditional Medicare FFS does not PA outpatient advanced imaging; Medicare Advantage varies by plan. Last verified 2026-06-12.
Frequently asked questions
Does Medicare (CMS LCD/NCD) require prior authorization for MRI Brain without contrast?
Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for MRI Brain without contrast (CPT 70551). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
What does Medicare (CMS LCD/NCD) require to approve MRI Brain without contrast?
Traditional Medicare (fee-for-service) generally does NOT require prior authorization for outpatient MRI/CT; the study is covered under Part B when medically necessary (the beneficiary pays the Part B coinsurance after the deductible). The CMS Appropriate Use Criteria (AUC) program that would have required consulting a qualified clinical decision support mechanism is PAUSED and its regulations (42… Always confirm against the current Medicare (CMS LCD/NCD) policy.
How long does a Medicare (CMS LCD/NCD) prior authorization take?
Turnaround varies by plan and submission method. Check the Medicare (CMS LCD/NCD) portal for current timeframes.
Submitting MRI Brain without contrast to Medicare (CMS LCD/NCD)?
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.