UnitedHealthcare MRI Upper Extremity Joint without contrast prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve MRI Upper Extremity Joint without contrast (CPT 73221), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
Medical-necessity criteria UnitedHealthcare generally applies
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when a rotator cuff abnormality or other internal derangement is suspected and initial shoulder radiographs are normal or inconclusive. MRI and MR arthrography are not routinely used in the initial evaluation of atraumatic shoulder pain; obtain radiographs first.
Situations to verify before submitting
UnitedHealthcare may not cover MRI Upper Extremity Joint without contrast in these situations. Verify against the current policy rather than assuming a denial:
- {"text":"Routine initial evaluation of atraumatic shoulder pain with MRI before radiographs (radiographs are the appropriate first study per ACR criteria)","source":"ACR Appropriateness Criteria: Shoulder Pain-Atraumatic"}
Source
Advanced imaging PA for UnitedHealthcare is managed by eviCore. Criteria summarized from ACR Appropriateness Criteria Atraumatic/Chronic Shoulder Pain. Source: jacr.org; eviCore radiology program. Last verified 2026-06-12.
Frequently asked questions
Does UnitedHealthcare require prior authorization for MRI Upper Extremity Joint without contrast?
Yes. UnitedHealthcare generally requires prior authorization for MRI Upper Extremity Joint without contrast (CPT 73221).
What does UnitedHealthcare require to approve MRI Upper Extremity Joint without contrast?
Shoulder MRI without contrast is appropriate (per ACR Appropriateness Criteria for Atraumatic/Chronic Shoulder Pain) when a rotator cuff abnormality or other internal derangement is suspected and initial shoulder radiographs are normal or inconclusive. MRI and MR arthrography are not routinely used in the initial evaluation of atraumatic shoulder pain; obtain radiographs first. 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 Upper Extremity Joint 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.