Which payers have published criteria for Cardiac MRI without contrast (CPT 75557)?

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 Cardiac MRI without contrast (CPT 75557)?

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 Cardiac MRI without contrast (CPT 75557)?

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 Cardiac MRI without contrast (CPT 75557) cost?

Across 711 hospitals that publish their negotiated rates, the median commercial insurance rate is $682, with the middle half of rates between $355 and $1,472. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if Cardiac MRI without contrast (CPT 75557) 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 75557: Cardiac MRI without contrast - Prior Authorization and Price

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CPT 75557

MRI of the heart conducted without the use of contrast.

MRI Heart

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Cardiac Imaging Guidelines effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026	19 that name this code
Anthem BCBS	Carelon	Imaging of the heart effective Nov 15, 2025	24 that name this code
Cigna	eviCore	Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026	19 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	19 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 Cardiac MRI without contrast. Each has its own criteria for when the study is considered appropriate.

Established flow-limiting CAD in patients who have new or worsening symptoms Anthem BCBS
Cardiomyopathy Anthem BCBS
Evaluation of the thoracic aorta Anthem BCBS
Intra-cardiac and para-cardiac masses and tumors Anthem BCBS
Valvular heart disease Anthem BCBS
Cardiac aneurysm and pseudoaneurysm Anthem BCBS
Congenital heart disease Anthem BCBS
Established flow-limiting CAD in asymptomatic patients Anthem BCBS
Established or suspected CAD Anthem BCBS
Evaluation of cardiac venous anatomy Anthem BCBS
Indications are organized as follows Anthem BCBS
Indications for Stress Cardiac MRI Anthem BCBS
Miscellaneous indications for PET perfusion imaging Anthem BCBS
Miscellaneous indications for stress cardiac MRI Anthem BCBS
Myocarditis Anthem BCBS
Suspected CAD in symptomatic patients who have not had evaluation for CAD within the preceding 60 days Anthem BCBS
Transplant Aetna · Cigna · UnitedHealthcare
Congestive Heart Failure Aetna · Cigna · UnitedHealthcare
Disorders of the Aorta and Visceral Arteries Aetna · Cigna · UnitedHealthcare
Hemochromatosis Aetna · Cigna · UnitedHealthcare
Infantile Hemangiomas Aetna · Cigna · UnitedHealthcare
Kawasaki Disease Aetna · Cigna · UnitedHealthcare
Magnetic Resonance Imaging Medicare

Typical price

Commercial insurance, median

$682

Middle half of rates: $355 to $1,472

Medicare, hospital outpatient

$244

Facility payment

Medicare, physician fee schedule

$281

National, non-facility

Commercial figures come from negotiated rates published by 711 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 Cardiac MRI without contrast change.

CPT 75557: Cardiac MRI 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 75557: Cardiac MRI 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