Who reviews prior authorization requests for Ultrasound imaging of soft tissues in the head and neck (CPT 76536)?

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 Ultrasound imaging of soft tissues in the head and neck (CPT 76536)?

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 76536: Ultrasound imaging of soft tissues in the head and neck - Prior Authorization and Price

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CPT 76536

Ultrasound imaging of soft tissues in the head and neck.

Ultrasound

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	22 that name this code
Anthem BCBS	Carelon	Current guideline	None found
Cigna	eviCore	Pediatric Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	21 that name this code
Medicare	CMS	—	None found
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	22 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 Ultrasound imaging of soft tissues in the head and neck. Each has its own criteria for when the study is considered appropriate.

Thyroid and Parathyroid Aetna · Cigna · UnitedHealthcare
Neck Mass/Swelling/Adenopathy Aetna · Cigna · UnitedHealthcare
Salivary Gland Disorders Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Cervical Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Dystonia/Torticollis Aetna · Cigna · UnitedHealthcare
Esophagus Aetna · Cigna · UnitedHealthcare
Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Neck Masses (Pediatric) Aetna · Cigna · UnitedHealthcare
Temporomandibular Joint Disease (TMJ) and Dental/Periodontal/Maxillofacial Imaging Aetna · Cigna · UnitedHealthcare
Thyroid Cancer Aetna · Cigna · UnitedHealthcare

Typical price

Commercial insurance, median

$326

Middle half of rates: $174 to $606

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$109

National, non-facility

Commercial figures come from negotiated rates published by 1,062 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 Ultrasound imaging of soft tissues in the head and neck change.

CPT 76536: Ultrasound imaging of soft tissues in the head and neck - 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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