Tufts Health Plan MRI Lumbar Spine without contrast prior authorization requirements (2026)
What Tufts Health Plan generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for Commercial plans. Yes. Tufts Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria Tufts Health Plan generally applies
Prior authorization required for elective outpatient advanced imaging; delegated to Evolent (formerly NIA) via RadMD. Per Evolent Clinical Guideline 044 (Lumbar Spine MRI), MRI is indicated for back pain with ANY of: new or worsening objective neurologic deficits; failure of conservative treatment for a minimum of 6 weeks within the last 6 months; progression of symptoms during conservative treatment; or abnormal EMG/NCS indicating lumbar radiculopathy. Also covered for neurologic deficits, pre/post-operative evaluation, trauma, compression fracture, pars defect/spondylolisthesis, tumor/metastasis, suspected infection, and cauda equina syndrome.
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
- conservative-treatment course and outcome
- prior imaging.
How to submit
- Method: Evolent / RadMD (Tufts Commercial 866-642-9703)
- Portal: RadMD (Evolent/NIA)
Source
Source: Evolent Clinical Guideline 044 (NIAEvolent_CG_044), delegated by Tufts Health Plan (Point32Health) via RadMD. Last verified 2026-06-17.
Frequently asked questions
Does Tufts Health Plan require prior authorization for MRI Lumbar Spine without contrast?
Yes. Tufts Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does Tufts Health Plan require to approve MRI Lumbar Spine without contrast?
Prior authorization required for elective outpatient advanced imaging; delegated to Evolent (formerly NIA) via RadMD. Per Evolent Clinical Guideline 044 (Lumbar Spine MRI), MRI is indicated for back pain with ANY of: new or worsening objective neurologic deficits; failure of conservative treatment for a minimum of 6 weeks within the last 6 months; progression of symptoms during conservative treatm… Always confirm against the current Tufts Health Plan policy.
How long does a Tufts Health Plan prior authorization take?
Turnaround varies by plan and submission method. Check the Tufts Health Plan portal for current timeframes.
Submitting MRI Lumbar Spine without contrast to Tufts 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.