Which payers have published criteria for MRI breast, both sides, without contrast (CPT 77047)?

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 breast, both sides, without contrast (CPT 77047)?

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 breast, both sides, without contrast (CPT 77047)?

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 breast, both sides, without contrast (CPT 77047) cost?

Across 799 hospitals that publish their negotiated rates, the median commercial insurance rate is $784, with the middle half of rates between $452 and $1,530. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if MRI breast, both sides, without contrast (CPT 77047) 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 77047: MRI breast, both sides, without contrast - Prior Authorization and Price

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CPT 77047

Conducting a bilateral breast MRI imaging without contrast dye.

MRI Breast

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Breast Imaging Guidelines 2.0.2026, effective Sep 1, 2026	3 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026 Imaging of the chest effective Apr 4, 2026	7 that name this code
Cigna	eviCore	Breast Imaging Guidelines 2.0.2026, effective Sep 1, 2026	3 that name this code
Medicare	CMS	NCD 220.2: Magnetic Resonance Imaging effective Apr 10, 2018 L33585: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (Wellpoint Federal) effective Apr 1, 2026 L33950: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (CGS Administrators) effective Dec 4, 2025	3 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	3 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 breast, both sides, without contrast. Each has its own criteria for when the study is considered appropriate.

MRI Breast Coding Aetna · Cigna · UnitedHealthcare
Breast Cancer Anthem BCBS
Breast cancer screening Anthem BCBS
Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography Medicare
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography Medicare
Breast implant rupture Anthem BCBS
Cancer Screening Anthem BCBS
Cancer screening, not otherwise specified Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Magnetic Resonance Imaging Medicare
Neuroendocrine Tumors Anthem BCBS

Typical price

Commercial insurance, median

$784

Middle half of rates: $452 to $1,530

Medicare, hospital outpatient

$244

Facility payment

Medicare, physician fee schedule

$218

National, non-facility

Commercial figures come from negotiated rates published by 799 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 breast, both sides, without contrast change.

CPT 77047: MRI breast, both sides, 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

Imaging CPT Code Coverage Lookup

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CPT 77047: MRI breast, both sides, 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