How to Appeal an MRI or Imaging Denial

Imaging denied as "not medically necessary"? These denials are most often a documentation gap, not a coverage gap — which makes them very winnable.

Why MRI or imaging claims get denied

• "Not medically necessary" — usually means conservative treatment wasn’t documented
• Conservative therapy (physical therapy, medication, time) not shown to have been tried first
• The plan’s imaging criteria (often InterQual or MCG) weren’t addressed in the request

The argument that wins

• Most imaging denials are a documentation failure, not an eligibility failure. The records that win the appeal usually already exist — they just weren’t submitted with the original request.
• Assemble and submit the conservative-care record: weeks of physical therapy, NSAIDs or other medications, and the timeline of symptoms.
• Cite the plan’s own imaging criteria back to it, and have your physician document the red-flag symptoms or failed conservative care that justify imaging now.

Evidence to gather

• Physical therapy notes and dates
• Records of medications tried (NSAIDs, muscle relaxants) and duration
• The duration and progression of your symptoms
• Your physician’s clinical rationale for imaging now

Frequently asked questions