MRI Lumbar Spine — Aetna

Score

98.0

Pass · 1m 48s

Criteria

Extracted correct diagnosis and clinical indication1.0

Verified imaging is medically necessary1.0

Submitted with correct CPT and ICD-10 codes0.9

Authorization obtained1.0

Patient

James Wilson, 45M

Primary Dx

M54.17 — Lumbar radiculopathy

Payer

Aetna HMO

Procedure

CPT 72148 — MRI Lumbar

Conservative Tx

6 weeks PT

BMI

31.2

Changes made by agent

Auth StatusNone→Approved (AET-2026-1190482)

Auth Expiry—→2026-06-20 (60 days)

Agent Activity

0:00

Read patient chart

Accessed patient demographics, conditions, encounter history. Identified lumbar radiculopathy with positive straight leg raise.

0:08

Checked payer requirements

Queried Aetna portal for MRI prior auth criteria. Requires conservative treatment trial and clinical indication.

0:22

Compiled clinical evidence

PT evaluation notes, neurology consult recommending MRI, documented failed conservative treatment.

1:05

Submitted to payer

Submitted via Aetna portal with clinical justification and supporting documentation.

1:48

Authorization received

Auth #AET-2026-1190482 approved. Updated patient record.