Which payers have published criteria for CT lumbar spine without and with contrast (CPT 72133)?

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 CT lumbar spine without and with contrast (CPT 72133)?

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 CT lumbar spine without and with contrast (CPT 72133)?

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.

What can be done if CT lumbar spine without and with contrast (CPT 72133) 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 72133: CT lumbar spine without and with contrast - Prior Authorization and Price

Home › CPT Codes › CT lumbar spine without and with contrast

CPT 72133

CT lumbar spine without and with contrast.

CT Spine

Build a submission checklist for this study

Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	3 that name this code
Anthem BCBS	Carelon	Imaging of the spine effective Sep 19, 2026 Oncologic imaging effective Apr 4, 2026	26 that name this code
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	3 that name this code
Medicare	CMS	NCD 220.1: Computed Tomography effective Mar 12, 2008	1 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	3 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 CT lumbar spine without and with contrast. Each has its own criteria for when the study is considered appropriate.

Axial spondyloarthropathy Anthem BCBS
Bone Sarcoma Anthem BCBS
Cancer screening, not otherwise specified Anthem BCBS
Cauda equina syndrome Anthem BCBS
Colorectal cancer screening Anthem BCBS
Congenital spinal cord anomalies not listed Anthem BCBS
Congenital vertebral defects Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Juvenile idiopathic arthritis (Pediatric only) Anthem BCBS
Low back pain or lumbar radiculopathy Anthem BCBS
Myelopathy Anthem BCBS
Neuroendocrine Tumors Anthem BCBS
Osteoporosis and osteopenia Anthem BCBS
Paget disease Anthem BCBS
Postoperative and postprocedural imaging, not otherwise specified Anthem BCBS
Scoliosis Anthem BCBS
Spinal cord infarction Anthem BCBS
Spinal dysraphism and tethered cord Anthem BCBS
Spinal infection Anthem BCBS
Spondylolisthesis (anterolisthesis or retrolisthesis) Anthem BCBS
Spondylolysis (pars defect) Anthem BCBS
Spontaneous (idiopathic) intracranial hypotension (SIH) Anthem BCBS
Suspected or Known Metastases Anthem BCBS
Thoracic or lumbar trauma Anthem BCBS
Tumor Anthem BCBS
Vertebral compression fracture Anthem BCBS
Ataxia Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Computed Tomography Medicare

Typical price

Commercial insurance, median

$931

Middle half of rates: $463 to $2,111

Medicare, hospital outpatient

$179

Facility payment

Medicare, physician fee schedule

$198

National, non-facility

Commercial figures come from negotiated rates published by 1,043 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 CT lumbar spine without and with contrast change.

CPT 72133: CT lumbar spine 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 72133: CT lumbar spine 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