Which payers have published criteria for MRI pelvis without and with contrast (CPT 72197)?

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 pelvis without and with contrast (CPT 72197)?

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 pelvis without and with contrast (CPT 72197)?

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 pelvis without and with contrast (CPT 72197) cost?

Across 1,052 hospitals that publish their negotiated rates, the median commercial insurance rate is $1,604, with the middle half of rates between $770 and $2,896. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if MRI pelvis without and with contrast (CPT 72197) 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 72197: MRI pelvis without and with contrast - Prior Authorization and Price

Home › CPT Codes › MRI pelvis without and with contrast

CPT 72197

Pelvic MRI imaging done with and without contrast material.

MRI Abdomen & Pelvis

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pelvis Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	153 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026 Imaging of the abdomen and pelvis effective Apr 4, 2026 Advanced imaging for vascular indications effective Sep 19, 2026	79 that name this code
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pelvis Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	157 that name this code
Medicare	CMS	NCD 220.2: Magnetic Resonance Imaging effective Apr 10, 2018	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	153 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 pelvis without and with contrast. Each has its own criteria for when the study is considered appropriate.

Neuroendocrine Cancers and Adrenal Tumors Aetna · Cigna · UnitedHealthcare
Upper GI Cancers Aetna · Cigna · UnitedHealthcare
Anal Cancer & Cancers of the External Genitalia Aetna · Cigna · UnitedHealthcare
Prostate Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Ovarian Cancer Aetna · Cigna · UnitedHealthcare
Colorectal and Small Bowel Cancer Aetna · Cigna · UnitedHealthcare
Testicular, Ovarian and Extragonadal Germ Cell Tumors Aetna · Cigna · UnitedHealthcare
Cervical Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Uterine Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Sarcomas – Bone, Soft Tissue, and GIST Aetna · Cigna · UnitedHealthcare
Transitional Cell Cancer Aetna · Cigna · UnitedHealthcare
Pancreatic Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Renal Cell Cancer (RCC) Aetna · Cigna · UnitedHealthcare
Pediatric Renal Tumors Aetna · Cigna · UnitedHealthcare
Abdominal Mass Aetna · Cigna · UnitedHealthcare
Fistulae, Abscess, and Pilonidal Cyst Aetna · Cigna · UnitedHealthcare
Inflammatory Bowel Disease Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Pediatric Liver and Pancreatic Tumors Aetna · Cigna · UnitedHealthcare
Periurethral Cysts, Urethral Diverticula, and Vaginal Masses Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Scrotal Pathology Aetna · Cigna · UnitedHealthcare
Hydronephrosis Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Abnormal Uterine Bleeding Aetna · Cigna · UnitedHealthcare
Adnexal Mass/Ovarian Cysts Aetna · Cigna · UnitedHealthcare
Amenorrhea Aetna · Cigna · UnitedHealthcare
Congenital (Mullerian) Uterine and Vaginal Anomalies Aetna · Cigna · UnitedHealthcare
Constipation, Diarrhea, and Irritable Bowel Syndrome Aetna · Cigna · UnitedHealthcare
Fistulae Aetna · Cigna · UnitedHealthcare
Flank Pain, Renal Stone Aetna · Cigna · UnitedHealthcare
GI Bleeding Aetna · Cigna · UnitedHealthcare
Inflammatory Bowel Disease, Crohn Disease, or Ulcerative Colitis Aetna · Cigna · UnitedHealthcare
Patent Urachus Aetna · Cigna · UnitedHealthcare
Pediatric Germ Cell Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Pelvic Inflammatory Disease (PID) Aetna · Cigna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · Cigna · UnitedHealthcare

Plus 105 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,604

Middle half of rates: $770 to $2,896

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$336

National, non-facility

Commercial figures come from negotiated rates published by 1,052 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 pelvis without and with contrast change.

CPT 72197: MRI pelvis 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

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CPT 72197: MRI pelvis 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