Which payers have published criteria for CT angiography pelvis (CPT 72191)?

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 angiography pelvis (CPT 72191)?

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 angiography pelvis (CPT 72191)?

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 CT angiography pelvis (CPT 72191) cost?

Across 976 hospitals that publish their negotiated rates, the median commercial insurance rate is $944, with the middle half of rates between $426 and $2,046. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if CT angiography pelvis (CPT 72191) 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 72191: CT angiography pelvis - Prior Authorization and Price

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CPT 72191

CT angiography of the blood vessels of the pelvis is done both without and with contrast dye.

CTA Abdomen & Pelvis

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pelvis Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026	17 that name this code
Anthem BCBS	Carelon	Advanced imaging for vascular indications effective Sep 19, 2026	14 that name this code
Cigna	eviCore	Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pelvis Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026	17 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	17 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 angiography pelvis. Each has its own criteria for when the study is considered appropriate.

Chronic limb swelling due to chronic deep venous thrombosis (DVT)/May-Thurner syndrome Aetna · Cigna · UnitedHealthcare
Adenomyosis Aetna · Cigna · UnitedHealthcare
Breast Reconstruction Aetna · Cigna · UnitedHealthcare
Congestive Heart Failure Aetna · Cigna · UnitedHealthcare
Impotence/Erectile Dysfunction Aetna · Cigna · UnitedHealthcare
Leiomyoma/Uterine Fibroids and other Uterine Masses Aetna · Cigna · UnitedHealthcare
Male Pelvic Disorders Aetna · Cigna · UnitedHealthcare
Mesenteric/Colonic Ischemia Aetna · Cigna · UnitedHealthcare
Pancreatic Cancer Aetna · Cigna · UnitedHealthcare
Post-Operative Spinal Disorders Aetna · Cigna · UnitedHealthcare
Spinal Deformities (e.g., Scoliosis/Kyphosis) Aetna · Cigna · UnitedHealthcare
Transplant Aetna · Cigna · UnitedHealthcare
Aneurysm of the abdominal aorta or iliac arteries Anthem BCBS
Aortic dissection and other aortopathies Anthem BCBS
Arteriovenous malformation (AVM) or fistula (AVF) Anthem BCBS
Computed Tomography Medicare
Congenital or developmental vascular anomalies, not otherwise specified Anthem BCBS
Evaluation for suspected vascular complications following a procedure Anthem BCBS
Hematoma/hemorrhage within the abdomen or pelvis Anthem BCBS
Mesenteric ischemia or mesenteric stenosis/occlusion Anthem BCBS
Stenosis or occlusion of the abdominal aorta or iliac arteries (aortoiliac peripheral arterial disease) Anthem BCBS
Traumatic vascular injury Anthem BCBS
Vascular anatomic delineation prior to surgical and interventional procedures, not otherwise specified* Anthem BCBS
Vasculitis Anthem BCBS
Visceral artery aneurysm Anthem BCBS

Typical price

Commercial insurance, median

$944

Middle half of rates: $426 to $2,046

Medicare, hospital outpatient

$179

Facility payment

Medicare, physician fee schedule

$305

National, non-facility

Commercial figures come from negotiated rates published by 976 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 angiography pelvis change.

CPT 72191: CT angiography pelvis - 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

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CPT 72191: CT angiography pelvis - 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