Does Aetna require prior authorization for CPT 70551?

Yes. Aetna requires prior authorization for CPT 70551 (MRI brain without contrast) under commercial plans in NY per its published clinical policy.

What documentation does Aetna require for CPT 70551?

Completed EviCore preauthorization request; Medical records requested for delegated clinical review

How long does Aetna take to respond to a PA request?

Standard Aetna commercial PA determinations are returned within 5–14 business days for non-urgent requests and 72 hours for urgent (expedited) requests, per state-regulated and contractual timelines.

What if Aetna denies the PA for CPT 70551?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Aetna Prior Authorization for CPT 70551

MRI brain without contrast · NY · commercial plans

Prior authorization REQUIREDVerified 2026-05-09 · Aetna

Source

Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Aetna lists this code under Special programs: Radiology imaging. The PDF states all members with plans that use this list need precertification, except inpatient facility, emergency room, or observation-bed status, and notes possible site-of-care requirements for MRI and CT scans in hospital outpatient settings. Evidence: PDF p.38, Special programs, Radiology imaging.

Documentation checklist

✓Completed EviCore preauthorization request
✓Medical records requested for delegated clinical review

Submission channels

Phone

1-888-622-7329

Fax

1-800-540-2406

How to submit the PA

1Verify the requirement against the current clinical policy PDF linked above.
2Gather documentation: Completed EviCore preauthorization request, Medical records requested for delegated clinical review.
3Submit via phone or fax, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 70551?: Yes. Aetna requires prior authorization for CPT 70551 (MRI brain without contrast) under commercial plans in NY per its published clinical policy.
What documentation does Aetna require for CPT 70551?: Completed EviCore preauthorization request; Medical records requested for delegated clinical review
How long does Aetna take to respond to a PA request?: Standard Aetna commercial PA determinations are returned within 5–14 business days for non-urgent requests and 72 hours for urgent (expedited) requests, per state-regulated and contractual timelines.
What if Aetna denies the PA for CPT 70551?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

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