UnitedHealthcare MRI Brain without contrast prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve MRI Brain without contrast (CPT 70551), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for MRI Brain without contrast (CPT 70551).
Medical-necessity criteria UnitedHealthcare generally applies
Brain MRI is appropriate (per ACR Appropriateness Criteria for Headache) for new or progressively worsening headache with one or more red flags: subacute head trauma; headache triggered by exertion, sexual activity, or position; neurologic deficit; known or suspected cancer; immunocompromised state; age 50 or older; thunderclap or abrupt-onset headache. Imaging is not indicated for uncomplicated migraine or tension-type headache with a normal neurologic examination.
Situations to verify before submitting
UnitedHealthcare may not cover MRI Brain without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Uncomplicated migraine or tension-type headache with a normal neurologic examination (neuroimaging not indicated per ACR criteria)","source":"ACR Appropriateness Criteria: Headache"}
Source
Advanced imaging PA for UnitedHealthcare is managed by eviCore. Criteria summarized from ACR Appropriateness Criteria Headache. Source: jacr.org; eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does UnitedHealthcare require prior authorization for MRI Brain without contrast?
Yes. UnitedHealthcare generally requires prior authorization for MRI Brain without contrast (CPT 70551).
What does UnitedHealthcare require to approve MRI Brain without contrast?
Brain MRI is appropriate (per ACR Appropriateness Criteria for Headache) for new or progressively worsening headache with one or more red flags: subacute head trauma; headache triggered by exertion, sexual activity, or position; neurologic deficit; known or suspected cancer; immunocompromised state; age 50 or older; thunderclap or abrupt-onset headache. Imaging is not indicated for uncomplicated m… Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting MRI Brain without contrast to UnitedHealthcare?
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.