Which payers have published criteria for MRI orbit, face and neck with contrast (CPT 70542)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for MRI orbit, face and neck with contrast (CPT 70542)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting MRI orbit, face and neck with contrast (CPT 70542)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does MRI orbit, face and neck with contrast (CPT 70542) cost?

Across 928 hospitals that publish their negotiated rates, the median commercial insurance rate is $1,246, with the middle half of rates between $655 and $2,297. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if MRI orbit, face and neck with contrast (CPT 70542) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 70542: MRI orbit, face and neck with contrast - Prior Authorization and Price

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CPT 70542

An MRI of the eye socket, face, and neck is conducted with contrast.

MRI Head & Neck

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	8 that name this code
Anthem BCBS	Carelon	Imaging of the head and neck effective Apr 14, 2024 Oncologic imaging effective Apr 4, 2026	32 that name this code
Cigna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	8 that name this code
Medicare	CMS	NCD 220.2: Magnetic Resonance Imaging effective Apr 10, 2018 L37373: MRI and CT Scans of the Head and Neck (Noridian Healthcare Solutions) effective Oct 23, 2025 L34425: Magnetic Resonance Imaging of the Head and Neck (Palmetto GBA) effective Mar 27, 2025	3 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	8 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss MRI orbit, face and neck with contrast. Each has its own criteria for when the study is considered appropriate.

Acoustic neuroma Anthem BCBS
Acute Leukemia Anthem BCBS
Cancer screening, not otherwise specified Anthem BCBS
Congenital and Developmental Conditions Anthem BCBS
Head and Neck Cancer Anthem BCBS
Hearing loss Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Hoarseness, dysphonia, and vocal cord weakness/paralysis – primary voice complaint Anthem BCBS
Horner’s syndrome Anthem BCBS
Infectious conditions – not otherwise specified Anthem BCBS
Inflammatory conditions – not otherwise specified Anthem BCBS
Laryngeal edema Anthem BCBS
Localized facial pain (including trigeminal neuralgia) Anthem BCBS
Melanoma Anthem BCBS
Merkel Cell Carcinoma Anthem BCBS
Neck mass (including lymphadenopathy) Anthem BCBS
Neuroendocrine Tumors Anthem BCBS
Osteonecrosis of the jaw Anthem BCBS
Paraneoplastic Syndrome Anthem BCBS
Recurrent epistaxis Anthem BCBS
Stridor Anthem BCBS
Suspected or Known Metastases Anthem BCBS
Temporomandibular joint dysfunction Anthem BCBS
Thyroid Cancer Anthem BCBS
Thyroid nodule or thyromegaly (goiter) Anthem BCBS
Thyroid ophthalmopathy Anthem BCBS
Tinnitus Anthem BCBS
Torticollis (Pediatric only) Anthem BCBS
Tracheal stenosis or upper airway obstruction Anthem BCBS
Trauma Anthem BCBS
Tumor – not otherwise specified Anthem BCBS
Visual disturbance or visual field defect Anthem BCBS
Hearing Loss and Tinnitus Aetna · Cigna · UnitedHealthcare
Acoustic Neuroma and Other Cerebellopontine Angle Tumors Aetna · Cigna · UnitedHealthcare
Dizziness, Vertigo and Syncope Aetna · Cigna · UnitedHealthcare
Mastoid Disease or Ear Pain Aetna · Cigna · UnitedHealthcare
Pediatric Ear Disorders Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Magnetic Resonance Imaging Medicare
Magnetic Resonance Imaging of the Head and Neck Medicare

Plus 1 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,246

Middle half of rates: $655 to $2,297

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$268

National, non-facility

Commercial figures come from negotiated rates published by 928 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for MRI orbit, face and neck with contrast change.

CPT 70542: MRI orbit, face and neck with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Imaging CPT Code Coverage Lookup

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CPT 70542: MRI orbit, face and neck with contrast - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET