WellSense Health Plan MRI Lumbar Spine without contrast prior authorization requirements (2026)
What WellSense Health Plan generally requires to approve MRI Lumbar Spine without contrast (CPT 72148), for MassHealth, Individual/ConnectorCare, Medicare plans. Yes. WellSense Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
Medical-necessity criteria WellSense Health Plan generally applies
Prior authorization required; delegated to eviCore radiology. All outpatient elective MR, CT, PET, and nuclear cardiac studies require prior authorization. CPT 72148 (MRI lumbar spine without contrast) is listed verbatim on the WellSense eviCore Radiology/Cardiology code list (effective 2026-01-01). Reviewed against eviCore radiology clinical guidelines.
Related procedure codes
Codes often billed alongside MRI Lumbar Spine without contrast: 72148. 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: eviCore (888-693-3211 prompt 4)
- Portal: eviCore healthcare
Source
Source: WellSense eviCore Radiology/Cardiology CPT list eff 01/01/2026; WellSense 2026 MA Provider Manual. Last verified 2026-06-17.
Frequently asked questions
Does WellSense Health Plan require prior authorization for MRI Lumbar Spine without contrast?
Yes. WellSense Health Plan generally requires prior authorization for MRI Lumbar Spine without contrast (CPT 72148).
What does WellSense Health Plan require to approve MRI Lumbar Spine without contrast?
Prior authorization required; delegated to eviCore radiology. All outpatient elective MR, CT, PET, and nuclear cardiac studies require prior authorization. CPT 72148 (MRI lumbar spine without contrast) is listed verbatim on the WellSense eviCore Radiology/Cardiology code list (effective 2026-01-01). Reviewed against eviCore radiology clinical guidelines. Always confirm against the current WellSense Health Plan policy.
How long does a WellSense Health Plan prior authorization take?
Turnaround varies by plan and submission method. Check the WellSense Health Plan portal for current timeframes.
Submitting MRI Lumbar Spine without contrast to WellSense 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.