This page shows prior authorization criteria extracted from Cigna (eviCore)'s published imaging guidelines. 128 matching coverage rules found for this procedure.
Abdominal Aortic Aneurysm (AAA)
Indication Code: PVD-6.3
Abdominal Veins Other than Hepatic and Portal Veins
Indication Code: AB-43.2
Abnormal Blood Clotting
Indication Code: HD-11.9
Acute deep venous thrombosis (DVT)
Indication Code: PVD-12.2
Aortic and Arterial Dissection and Other Aortic Conditions
Indication Code: PVD-6.7
Aortic Congenital Vascular Malformations
Indication Code: PEDPVD-4.2
Arteriovenous Malformations (AVMs) and Related Lesions
Indication Code: HD-12.2
Autoimmune/Paraneoplastic Encephalitis & Neuroinflammatory Disorders
Indication Code: HD-14.3
Bariatric Post-Operative Complications
Indication Code: AB-9.1
Basilar Impression/Basilar Invagination
Indication Code: HD-5.4
Breast Reconstruction
Indication Code: BR-3.1
Cardiac CT and CTA-General information and Coding
Indication Code: CD-4.1
Cardiac Trauma Imaging
Indication Code: CD-10.1
Cardiac Trauma Imaging
Indication Code: CD-10.1
CCTA – Indications for CCTA
Indication Code: CD-4.3
CCTA – Regardless of Symptoms
Indication Code: CD-4.4
Cerebral Aneurysms
Indication Code: HD-12.1
Cerebral Vasculitis
Indication Code: HD-22.1
Cerebral Venous Sinus Thrombosis
Indication Code: HD-21.8
Cerebrovascular and Carotid Disease - Initial Imaging
Indication Code: PVD-3.1
CHF – Imaging
Indication Code: CD-9.1
Chiari III and IV Malformations
Indication Code: HD-5.3
Chronic DVT with incompletely lysed or residual DVT
Indication Code: PVD-13.1
Claudication and Critical Limb Ischemia
Indication Code: PVD-7.1
CNS and Head Infection
Indication Code: HD-14.1
CNS Vasculitis
Indication Code: PEDHD-12.6
Colonic ischemia (including ischemic colitis)
Indication Code: AB-6.2
Congenital Heart Disease Coding
Indication Code: PEDCD-2.2
Congenital Heart Disease Modality Considerations
Indication Code: PEDCD-2.3
COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)
Indication Code: PEDHD-12.7
Craniopharyngioma and Other Tumors of the Sellar Region
Indication Code: PEDONC-4.10
CT Heart for Evaluation of Cardiac Structure and Morphology
Indication Code: CD-4.6
CT or MRI Perfusion
Indication Code: HD-24.5
Dizziness/Vertigo
Indication Code: HD-23.1
Dysphagia
Indication Code: PEDNECK-5.1
Dysphagia and Upper Digestive Tract Disorders
Indication Code: NECK-3.1
Eagle Syndrome
Indication Code: NECK-10.3
Epistaxis
Indication Code: HD-25.1
Eye Disorders and Visual Loss
Indication Code: HD-32.1
Facial Palsy
Indication Code: HD-6.1
Fungal Infections (Suspected or Known)
Indication Code: CH-14.2
General Guidelines
Indication Code: PEDCD-1.0
General Guidelines – CT and MR Angiography (CTA/CTV and MRA/MRV)
Indication Code: HD-1.5
General Guidelines – CTA Chest (CPT® 71275)
Indication Code: CH-1.4
GI Bleeding
Indication Code: AB-22.1
Head Trauma
Indication Code: HD-13.1
Headache and Suspected Vascular Dissection
Indication Code: HD-11.1
Headache General Guidelines
Indication Code: HD-11.0
Hemifacial Spasm
Indication Code: HD-6.2
Hemodialysis access imaging
Indication Code: PVD-8.2
Hemophagocytic Lymphohistiocytosis (HLH)
Indication Code: PEDONC-18.3
Hemoptysis
Indication Code: CH-6.1
Hemoptysis – Imaging
Indication Code: PEDCH-4.1
Hepatic Arteries and Veins
Indication Code: AB-43.1
Histiocytic Disorders – General Considerations
Indication Code: PEDONC-18.1
Iliac Artery Aneurysm (IAA)
Indication Code: PVD-6.4
Imaging in Pregnancy with Congenital Heart Disease (CHD)
Indication Code: CD-15.4
Imaging Indications in Sinusitis
Indication Code: PEDHD-5.2
Implantable Contraceptive Devices
Indication Code: PV-10.3
Indications for Cardiac MRI
Indication Code: PEDCD-9.3
IVC filters – Treatment
Indication Code: PVD-16.2
Kawasaki Disease Initial Imaging
Indication Code: PEDCD-6.1
Kidney Transplant, Pre-Transplant Imaging Studies
Indication Code: AB-42.5
Langerhans Cell Histiocytosis (LCH)
Indication Code: PEDONC-18.2
Large Vessel Vasculitis
Indication Code: PVD-6.9
Left Ventricular Assist Devices (LVAD)
Indication Code: CD-9.4
Liver Transplant, Pre-Transplant
Indication Code: AB-42.1
Maternal Imaging in Individuals with Aortopathy
Indication Code: CD-15.3
May-Thurner syndrome
Indication Code: PVD-13.3
Mesenteric Ischemia
Indication Code: AB-6.1
Minimally Invasive or Robotic Cardiac Surgery
Indication Code: CD-13.4
Modality General Considerations
Indication Code: PEDNECK-1.3
Moyamoya Syndrome/Disease
Indication Code: HD-21.5
Neck Trauma
Indication Code: NECK-10.4
Neuro-COVID-19 and Sars-CoV-2 Vaccines
Indication Code: HD-14.2
Neuronavigation
Indication Code: HD-28.2
Non-Cardiac Chest Pain – Imaging
Indication Code: CH-4.1
Non-Langerhans Cell Histiocytoses
Indication Code: PEDONC-18.4
Papilledema/Pseudotumor Cerebri
Indication Code: HD-17.1
Pediatric Head Imaging Modality General Considerations
Indication Code: PEDHD-1.3
Pediatric Headache
Indication Code: PEDHD-3.1
Pediatric Intracranial Aneurysms and Subarachnoid Hemorrhage
Indication Code: PEDHD-10.1
Pediatric Intracranial Arteriovenous Malformations (AVM)
Indication Code: PEDHD-10.2
Pediatric Pulmonary Hypertension General
Indication Code: PEDCD-7.1
Pediatric Stroke Initial Imaging
Indication Code: PEDHD-12.2
Pediatric Stroke Subsequent Imaging
Indication Code: PEDHD-12.3
Pelvic congestion syndrome
Indication Code: PVD-13.4
Physical Exertion
Indication Code: HD-11.11
Pituitary
Indication Code: HD-19.1
Platybasia
Indication Code: HD-5.5
Pleural-Based Nodules and Other Abnormalities
Indication Code: CH-17.1
Post Aortic Endovascular/Open Surgery Surveillance Studies
Indication Code: PVD-6.8
Post-Transplant Imaging Studies
Indication Code: CH-32.2
Pre-operative Assessment for Robotic Kidney Surgery
Indication Code: AB-35.2
Pre-Transplant Imaging Studies
Indication Code: CH-32.1
Pregnancy
Indication Code: HD-11.10
Primary Central Nervous System Tumors – General Considerations
Indication Code: ONC-2.1
Pulmonary AVM
Indication Code: CH-24.1
Pulmonary Embolism
Indication Code: CH-25.1
Pulmonary Sequestration
Indication Code: PEDCH-14.4
Pulmonary Vein Imaging – Indications
Indication Code: CD-8.2
Pupillary Abnormalities Including Horner’s Syndrome
Indication Code: HD-32.2
Revision Anterior Fusion Surgery
Indication Code: SP-15.4
Revision Anterior Spinal Deformity Surgery
Indication Code: SP-14.2
Screening for TAA with bicuspid aortic valves
Indication Code: PVD-2.3
Screening for Vascular related genetic connective tissue Disorders
Indication Code: PVD-2.2
Sickle Cell Disease
Indication Code: HD-21.6
Skull Base Osteomyelitis (SBO)
Indication Code: HD-20.2
Solitary Pulmonary Nodule
Indication Code: CH-16.0
Solitary Pulmonary Nodule – Imaging
Indication Code: CH-16.1
Special Imaging Studies in Evaluation for Epilepsy Surgery
Indication Code: PEDHD-6.3
Stroke/TIA
Indication Code: HD-21.1
Sudden Onset of Headache
Indication Code: HD-11.3
Surveillance Imaging WITH History of Carotid Surgery or Intervention
Indication Code: PVD-3.3
Surveillance Imaging with NO History of Carotid Surgery or Intervention
Indication Code: PVD-3.2
Suspected Retroperitoneal Bleed
Indication Code: PVD-20
Syncope
Indication Code: HD-23.2
Thoracic Aortic Aneurysm (TAA)
Indication Code: PVD-6.2
Tinnitus
Indication Code: PEDHD-16.5
Tinnitus
Indication Code: HD-27.2
Transcatheter Aortic Valve Replacement (TAVR)
Indication Code: CD-4.8
Transcatheter Valve Interventions
Indication Code: CD-13.5
Trigeminal Neuralgia/Trigeminal Neuropathy
Indication Code: HD-10.1
Unilateral lower extremity edema
Indication Code: PVD-12.6
Upper Extremity PVD – Imaging
Indication Code: PVD-4.1
Upper Extremity Venous – Imaging
Indication Code: PVD-4.2
Vascular Ring
Indication Code: PEDCH-13.1
Venous Malformations
Indication Code: PEDPVD-2.3
Standard prior authorization requests are typically processed within 3–5 business days. Urgent/expedited requests may be processed within 24–72 hours when clinically necessary.
Most plans allow 30–60 days to file a first-level appeal. Expedited appeals for urgent cases are typically processed within 72 hours.
⚠ This study uses ionizing radiation. Payers may ask that non-ionizing alternatives (MRI, ultrasound) be considered first when clinically appropriate.