Prior Authorization
Humana Prior Authorization for CPT 72148
MRI lumbar spine without contrast · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)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
Humana requires prior authorization for lumbar spine MRI. Approved for radiculopathy with documented neurological findings after 6 weeks of conservative management, suspected cauda equina syndrome, cancer staging, or spinal infection. Plain radiographs should be obtained first unless urgent red flags are present.
Documentation checklist
- ✓Clinical notes with symptom timeline
- ✓Physical exam with neurological findings
- ✓Conservative treatment documentation
- ✓X-ray results if obtained
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 72148
Office (non-facility)
$191.72
Facility
$191.72
Total RVUs (office)
5.74
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 72148 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes with symptom timeline, Physical exam with neurological findings, Conservative treatment documentation….
- 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 Humana require prior authorization for CPT 72148?
- Yes. Humana requires prior authorization for CPT 72148 (MRI lumbar spine without contrast) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 72148?
- Clinical notes with symptom timeline; Physical exam with neurological findings; Conservative treatment documentation; X-ray results if obtained
- How much does Medicare pay for CPT 72148 in 2026?
- In 2026, the national Medicare allowable for CPT 72148 is $191.72 in an office setting and $191.72 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 72148?
- 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 Humana PA lookups
CPT 72148 prior authorization by payer
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