Which payers have published criteria for MRI leg joint (hip, knee or ankle) without contrast (CPT 73721)?

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 leg joint (hip, knee or ankle) without contrast (CPT 73721)?

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 leg joint (hip, knee or ankle) without contrast (CPT 73721)?

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 73721: MRI leg joint (hip, knee or ankle) without contrast - Prior Authorization and Price

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CPT 73721

Imaging of the leg joint using MRI done without contrast.

MRI Leg, Hip & Knee

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	23 that name this code
Anthem BCBS	Carelon	Imaging of the extremities effective Sep 19, 2026 Oncologic imaging effective Apr 4, 2026	35 that name this code
Cigna	eviCore	Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	23 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	23 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 leg joint (hip, knee or ankle) without contrast. Each has its own criteria for when the study is considered appropriate.

Post-Operative Follow-Up Aetna · Cigna · UnitedHealthcare
Capsular/Synovial and Meniscal Dysfunction Aetna · Cigna · UnitedHealthcare
Chondral/Osteochondral Lesions Aetna · Cigna · UnitedHealthcare
Foreign and Loose Bodies Aetna · Cigna · UnitedHealthcare
General Pain Aetna · Cigna · UnitedHealthcare
Infection Aetna · Cigna · UnitedHealthcare
Joint Instability and Dysfunction Aetna · Cigna · UnitedHealthcare
Ligament and Fascia Injury Aetna · Cigna · UnitedHealthcare
Muscle/Tendon Unit Injuries/Diseases Aetna · Cigna · UnitedHealthcare
Osteonecrosis/Avascular Necrosis Aetna · Cigna · UnitedHealthcare
Tissue Growths, Masses and Cysts Aetna · Cigna · UnitedHealthcare
Popliteal (Baker) Cyst Aetna · Cigna · UnitedHealthcare
Slipped Capital Femoral Epiphysis (SCFE) Aetna · Cigna · UnitedHealthcare
Avascular Necrosis (AVN) / Legg-Calvé-Perthes Disease / Idiopathic Osteonecrosis Aetna · Cigna · UnitedHealthcare
Developmental Dysplasia of the Hip Aetna · Cigna · UnitedHealthcare
Focal Neuropathy Aetna · Cigna · UnitedHealthcare
Infantile Hemangiomas Aetna · Cigna · UnitedHealthcare
Limping Child Aetna · Cigna · UnitedHealthcare
Pediatric Leukemias Aetna · Cigna · UnitedHealthcare
Acute traumatic injuries –not otherwise specified Anthem BCBS
Avascular necrosis Anthem BCBS
Cancer screening, not otherwise specified Anthem BCBS
Congenital or developmental anomalies of the extremity (Pediatric only) Anthem BCBS
Fracture Anthem BCBS
Hemarthrosis Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Indeterminate bone lesion Anthem BCBS
Intra-articular loose body Anthem BCBS
Juvenile idiopathic arthritis (Pediatric only) Anthem BCBS
Knee arthroplasty, presurgical planning Anthem BCBS
Labral tear and femoral acetabular impingement – hip Anthem BCBS
Legg-Calve-Perthes disease (Pediatric only) Anthem BCBS
Ligament and tendon injury and rupture – foot and ankle Anthem BCBS
Ligament tear – knee Anthem BCBS
Lisfranc injury Anthem BCBS
Lower extremity pain, not otherwise specified Anthem BCBS
Magnetic Resonance Imaging Medicare
Meniscal tear/injury Anthem BCBS
Morton’s neuroma Anthem BCBS
Myositis Anthem BCBS

Plus 15 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$1,112

Middle half of rates: $538 to $2,063

Medicare, hospital outpatient

$244

Facility payment

Medicare, physician fee schedule

$205

National, non-facility

Commercial figures come from negotiated rates published by 1,055 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 leg joint (hip, knee or ankle) without contrast change.

CPT 73721: MRI leg joint (hip, knee or ankle) without 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

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CPT 73721: MRI leg joint (hip, knee or ankle) without 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