Which payers have published criteria for MRI orbit, face and neck without and with contrast (CPT 70543)?

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 without and with contrast (CPT 70543)?

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 without and with contrast (CPT 70543)?

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.

CPT 70543: MRI orbit, face and neck without and with contrast - Prior Authorization and Price

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CPT 70543

MRI of the eye socket, face, and neck is conducted both without and 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 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	76 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 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	77 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	75 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 without and with contrast. Each has its own criteria for when the study is considered appropriate.

Multiple Sclerosis (MS) and Related Conditions Aetna · Cigna · UnitedHealthcare
Epistaxis Aetna · Cigna · UnitedHealthcare
Eye Disorders and Visual Loss Aetna · Cigna · UnitedHealthcare
Hearing Loss and Tinnitus Aetna · Cigna · UnitedHealthcare
Trigeminal Neuralgia and other Centrally Mediated Facial Pain Syndromes Aetna · Cigna · UnitedHealthcare
Acoustic Neuroma and Other Cerebellopontine Angle Tumors Aetna · Cigna · UnitedHealthcare
Cerebral Aneurysm and AVM Aetna · Cigna · UnitedHealthcare
CNS and Head Infection/Neuro-COVID-19 Aetna · Cigna · UnitedHealthcare
Cranial Neuropathies Aetna · Cigna · UnitedHealthcare
Dizziness, Vertigo and Syncope Aetna · Cigna · UnitedHealthcare
Facial Palsy (Bell's Palsy)/Hemifacial Spasm Aetna · Cigna · UnitedHealthcare
Head and Facial Trauma Aetna · Cigna · UnitedHealthcare
Headache Aetna · Cigna · UnitedHealthcare
Mastoid Disease or Ear Pain Aetna · Cigna · UnitedHealthcare
Papilledema/Pseudotumor Cerebri Aetna · Cigna · UnitedHealthcare
Pituitary, Sella, Hypothalamus Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Sinus and Facial Imaging Aetna · Cigna · UnitedHealthcare
Taste and Smell Disorders Aetna · Cigna · UnitedHealthcare
Pediatric Ear Disorders Aetna · Cigna · UnitedHealthcare
Salivary Gland Cancers Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Squamous Cell Carcinomas of the Head and Neck Aetna · Cigna · UnitedHealthcare
Thyroid and Parathyroid Aetna · Cigna · UnitedHealthcare
Thyroid Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Sinusitis and Allergic Rhinitis Aetna · Cigna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Brachial Plexus Aetna · Cigna · UnitedHealthcare
Cervical Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Craniofacial Anomalies Aetna · Cigna · UnitedHealthcare
Dystonia/Torticollis Aetna · Cigna · UnitedHealthcare
Eye Disorders Aetna · Cigna · UnitedHealthcare
Histiocytic Disorders Aetna · Cigna · UnitedHealthcare
Imaging of the Larynx, Trachea, and Bronchus Aetna · Cigna · UnitedHealthcare
Infantile Hemangiomas Aetna · Cigna · UnitedHealthcare
Intracranial Aneurysms and AVM Aetna · Cigna · UnitedHealthcare
Neck Mass/Swelling/Adenopathy Aetna · Cigna · UnitedHealthcare

Plus 43 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,552

Middle half of rates: $700 to $2,945

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$339

National, non-facility

Commercial figures come from negotiated rates published by 1,040 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 without and with contrast change.

CPT 70543: MRI orbit, face and neck without and 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

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET

CPT 70543: MRI orbit, face and neck without and 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