Prior Auth Required

72195 - Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) Prior Authorization Required Only if POS is 22 (On Campus-Outpatient Hospital)

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceMagnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) Prior Authorization Required Only if POS is 22 (On Campus-Outpatient Hospital)
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by Prior Authorization Required Only if POS is 22 (On Campus-Outpatient Hospital) contrast material(s) and further sequences; lumbar 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) Prior Authorization Required Only if POS is 22 (On Campus-Outpatient Hospital) 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) Prior Authorization Required Only if POS is 22 (On Campus-Outpatient Hospital) and further sequences

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.