Does Anthem require prior authorization for CPT 70553?

Yes. Anthem requires prior authorization for CPT 70553 (MRI brain with and without contrast) under Standard commercial plans per its published clinical policy.

What documentation does Anthem require for CPT 70553?

Clinical notes with neurological exam; Prior imaging reports; Treating physician order with clinical indication

How much does Medicare pay for CPT 70553 in 2026?

In 2026, the national Medicare allowable for CPT 70553 is $316.97 in an office setting and $316.97 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.

What if Anthem denies the PA for CPT 70553?

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

Anthem Prior Authorization for CPT 70553

MRI brain with and without contrast · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified January 1, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Anthem clinical policy

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

Anthem requires prior authorization for brain MRI with and without contrast via AIM Specialty Health. Criteria include new focal neurological deficit, new-onset seizures, suspected intracranial mass, pituitary evaluation, or MS workup. Documentation must include neurological exam findings and symptom timeline.

Documentation checklist

✓Clinical notes with neurological exam
✓Prior imaging reports
✓Treating physician order with clinical indication

Submission channels

Phone

1-800-274-7767

2026 Medicare rate for CPT 70553

Office (non-facility)

$316.97

Facility

$316.97

Total RVUs (office)

9.49

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Anthem's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 70553 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Clinical notes with neurological exam, Prior imaging reports, Treating physician order with clinical indication.
3Submit via phone, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Anthem require prior authorization for CPT 70553?: Yes. Anthem requires prior authorization for CPT 70553 (MRI brain with and without contrast) under Standard commercial plans per its published clinical policy.
What documentation does Anthem require for CPT 70553?: Clinical notes with neurological exam; Prior imaging reports; Treating physician order with clinical indication
How much does Medicare pay for CPT 70553 in 2026?: In 2026, the national Medicare allowable for CPT 70553 is $316.97 in an office setting and $316.97 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.
What if Anthem denies the PA for CPT 70553?: 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.

Other Anthem PA lookups

CPT 70450 CPT 72148 CPT 73721 CPT 74177 CPT 73221 CPT 76641 CPT 76942 CPT 70551

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CPT 70553 prior authorization by payer

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