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Aetna Prior Authorization for Imaging: Phone, Portal, Forms

Where to submit a Aetna prior authorization for MRI, CT and PET, the phone number to call, the forms and code lists, and the guidelines the reviewer uses.

Aetna hands advanced imaging reviews to eviCore. Radiology and cardiology requests are started on the eviCore portal, not on Availity.

Where to submit

eviCore provider portal (radiology and cardiology requests)
evicore.com

Reviews are done by eviCore by Evernorth.

Phone

888-632-3862
Aetna Provider Contact Center

800-918-8924
eviCore

Forms, lists and appeals

What to know

  • Services eviCore pre-approves for Aetna include CT and CTA, MRI and MRA, PET, nuclear cardiac imaging and stress echocardiograms.
  • Since January 1, 2026 eviCore no longer handles authorizations for Aetna Individual & Family Plan members; those go to Aetna directly.
  • For fully insured commercial members, eviCore also reviews whether an MRI or CT needs to be done in a hospital outpatient setting (site of care).

Checked against evicore.com on September 29, 2026. Plans change their vendors and phone numbers; if something here is out of date, tell us.

Guideline sections by body area

The 1555 sections of Aetna's imaging guidelines held on this site, grouped by body area. Look up a CPT code to see which apply to a study.

Abdomen (242)

  • AB-18.1: AAA, IAA, Post Endovascular or Open Aortic Repair
  • AB-17.1: Abdominal Aortic Aneurysm (AAA)
  • AB-18: Abdominal Aortic Aneurysm (AAA) and Iliac Artery Aneurysm (I...
  • AB-17: Abdominal Aortic Aneurysm (AAA), Iliac Artery Aneurysm (IAA)...
  • AB-8: Abdominal Lymphadenopathy
  • AB-8.1: Abdominal Lymphadenopathy
  • PEDAB-24: Abdominal Lymphadenopathy
  • PEDAB-24: Abdominal Lymphadenopathy
  • + 234 more

Breast (31)

  • BR-13: 3D Rendering
  • BR-13.1: 3D Rendering
  • BR-8: Alternative Breast Imaging Approaches
  • BR-8.1: Alternative Breast Imaging Approaches
  • BR-10: Breast Evaluation in Pregnant or Lactating Females
  • BR-10.1: Breast Evaluation in Pregnant or Lactating Females
  • BR-9: Breast Imaging in Males
  • BR-9.1: Breast Imaging in Males
  • + 23 more

Cardiac (97)

  • CD-2.9: 3D Echocardiography
  • CD-2.9: 3D Echocardiography – Indications
  • CD-4.9: 3D Predictive Model Generation for Pre-planning of Cardiac P...
  • CD-4.5: Anatomical and Functional Analysis of CCTA Results
  • PEDCD-11.1: Cardiac Catheterization General Information
  • PEDCD-11.2: Cardiac Catheterization Indications
  • CD-4.1: Cardiac CT and CTA-General information and Coding
  • CD-16: Cardiac Imaging in Transplants
  • + 89 more

Chest (123)

  • CH-7.2: Adult Cystic Fibrosis
  • CH-9: Asbestos Exposure
  • CH-9.1: Asbestos Exposure
  • PEDCH-10: Asthma
  • PEDCH-10.1: Asthma
  • CH-2.2: Axillary Lymphadenopathy (and Mass)
  • PEDCH-12: Breast Masses
  • PEDCH-12.1: Breast Masses
  • + 115 more

Head (253)

  • HD-11.9: Abnormal Blood Clotting
  • HD-33: Acoustic Neuroma and Other Cerebellopontine Angle Tumors
  • HD-33.1: Acoustic Neuroma and Other Cerebellopontine Angle Tumors
  • PEDHD-13.3: Acoustic Neuromas
  • PEDHD-14.3: Acute Disseminated Encephalomyelitis (ADEM) and Other Pediat...
  • HD-11.17: Advanced Imaging Indications Related To Migraines
  • PEDHD-5.5: Allergic Rhinitis
  • HD-35: Arachnoid Cysts
  • + 245 more

Musculoskeletal (101)

  • MS-3: 3D Rendering
  • MS-3.1: 3D Rendering
  • PEDMS-2.1: Acute Fracture
  • MS-5.1: Acute Fractures
  • PEDMS-1.1: Age Considerations
  • PEDMS-1.2: Appropriate Clinical Evaluation and Conservative Treatment
  • MS-12: Arthritis and Joint Degeneration
  • PEDMS-6: Avascular Necrosis (AVN) / Legg-Calvé-Perthes Disease / Idi...
  • + 93 more

Neck (46)

  • PEDNECK-1.1: Age Considerations
  • PEDNECK-3: Cervical Lymphadenopathy
  • PEDNECK-5: Dysphagia
  • PEDNECK-5.1: Dysphagia
  • NECK-3: Dysphagia and Upper Digestive Tract Disorders
  • NECK-3.1: Dysphagia and Upper Digestive Tract Disorders
  • PEDNECK-4: Dystonia/Torticollis
  • PEDNECK-4.1: Dystonia/Torticollis
  • + 38 more

Oncology (345)

  • ONC-26.2: Acute Leukemias
  • PEDONC-3.2: Acute Lymphoblastic Leukemia (ALL)
  • PEDONC-3.3: Acute Myeloid Leukemia (AML)
  • ONC-31.4: Adrenal Gland Metastases
  • ONC-15.10: Adrenal Tumors – Initial Work-up/Staging
  • ONC-15.11: Adrenal Tumors – Restaging/Recurrence
  • ONC-15.12: Adrenal Tumors – Surveillance
  • ONC-15.9: Adrenal Tumors – Suspected/Diagnosis
  • + 337 more

Pelvis (110)

  • PV-15.5: Abnormal Non-Invasive Prenatal Testing (NIPT) and Maternal M...
  • PV-2: Abnormal Uterine Bleeding
  • PEDPV-2: Abnormal Uterine Bleeding
  • PEDPV-2.1: Abnormal Uterine Bleeding
  • PV-2.1: Abnormal Uterine Bleeding (AUB)
  • PV-21.2: Abscess
  • PV-4: Adenomyosis
  • PV-4.1: Adenomyosis
  • + 102 more

Peripheral Nerve (38)

  • PEDPN-1.1: Age Considerations
  • PN-4: Brachial Plexus
  • PEDPN-3: Brachial Plexus
  • PN-4.1: Brachial Plexus
  • PEDPN-3.1: Brachial Plexus
  • PN-8.3: Fasciculations
  • PN-2: Focal Neuropathy
  • PN-2.1: Focal Neuropathy
  • + 30 more

Peripheral Vascular (72)

  • PVD-6.3: Abdominal Aortic Aneurysm (AAA)
  • PVD-12.2: Acute deep venous thrombosis (DVT)
  • PVD-12: Acute Limb Swelling
  • PEDPVD-1.1: Age Considerations
  • PVD-6.7: Aortic and Arterial Dissection and Other Aortic Conditions
  • PEDPVD-4.2: Aortic Congenital Vascular Malformations
  • PVD-6.1: Aortic Disorders General Information
  • PVD-8.1: Arterial Evaluation and Venous Mapping Prior to AV Fistula
  • + 64 more

Spine (97)

  • SP-2.12: 3D Rendering
  • PEDSP-7.1: Achondroplasia
  • SP-2.1: Anatomic Guidelines
  • PEDSP-7.3: Atlantoaxial Instability in Trisomy 21 (Down Syndrome)
  • PEDSP-2.2: Back and Neck Pain in Children Age 5 and Under
  • PEDSP-2.3: Back and Neck Pain in Children Age 6 and Older
  • PEDSP-7.4: Basilar Impression
  • PEDSP-7.5: Chiari Malformation
  • + 89 more

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