Appeal guide · Imaging

MRI and imaging denials

MRI, CT, PET, and other imaging denials are almost always issued at the prior-auth stage. They move fast — and so should the appeal.

What gets denied

MRI of brain, spine, joints, abdomen
CT with contrast
PET scans (oncology, neurology)
Cardiac imaging (echo, MUGA, stress)
Repeat imaging within 90 days

Common denial reasons

Conservative imaging (X-ray, ultrasound) not tried first
Documented symptoms don't match imaging request
Out-of-network imaging facility
Plan claims it's a 'screening,' not diagnostic
ICD coding doesn't justify the CPT requested

How we approach the appeal

Mark the appeal as urgent — most plans honor this when the ordering physician signs off. Request peer-to-peer the same day. Provide symptom documentation that maps directly to the imaging-justification ICD codes.

Filing window

Urgent designation compresses response to 72 hours. Standard: 30 days. Most plans: 180-day filing window.

Typical recovery

$500 – $5,000 per study

Documents we'll ask for

· Denial letter
· Order from referring physician
· Symptom history / ordering physician's notes
· Prior imaging results (if any)

Got a imaging denial?

Free 24-hour review. Send the denial letter and we'll tell you whether your case has a shot and what the next step would look like.

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This page provides general information about appeal strategy. It is not legal advice. Outcomes depend on documentation, plan terms, and timing.