73221ImagingCPT

MRI of Upper Extremity Joint (Shoulder) without Contrast

Last verified: March 2026

What is this procedure?

Magnetic resonance imaging of an upper extremity joint such as the shoulder without intravenous contrast. Used to evaluate rotator cuff tears, labral pathology, impingement syndrome, biceps tendon abnormalities, and other soft tissue injuries of the shoulder.

Does this require prior authorization?

Yes — Prior authorization is typically required

Common Reasons This Gets Denied

Based on insurer policy analysis and claims data patterns. Frequency indicates how often this reason appears.

Conservative Treatment Not Exhausted

Very Common

Insurer requires documentation of 4-6 weeks of physical therapy, NSAIDs, and rest before approving advanced imaging.

How to prevent this

Document at least 4-6 weeks of PT, ice, NSAIDs, and activity modification before requesting MRI. Include PT notes showing lack of improvement.

X-ray Not Obtained First

Common

Many insurers require plain X-rays as the initial imaging study before approving MRI.

How to prevent this

Always obtain shoulder X-rays (AP, outlet, axillary views) before requesting MRI. Document X-ray findings in the auth request.

Insufficient Clinical Documentation

Common

Request lacks specific physical exam findings, range of motion measurements, or clinical correlation.

How to prevent this

Include detailed shoulder exam: ROM measurements, strength testing, impingement signs (Neer, Hawkins), instability tests.

Documentation Checklist

Gather these documents before submitting your authorization request. Click items to check them off.

Medical Necessity Tips

What clinical evidence supports approval

  • Document failure of 4-6 weeks of conservative treatment (PT, NSAIDs, rest)
  • Physical exam findings suggesting rotator cuff tear or labral injury
  • Initial X-rays should be obtained to evaluate for calcific tendinitis or fracture
  • Positive impingement or instability tests on exam support necessity

What to Do If Denied

If your mri of upper extremity joint (shoulder) without contrast is denied, you have the right to appeal. Most denials are overturned on appeal when proper documentation is provided.

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This information is for educational purposes only and is not medical, legal, or financial advice. Coverage decisions depend on your specific plan, insurer, and clinical circumstances. Always verify with your insurance company and healthcare provider.

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