Prior authorization approved

This letter confirms that the prior-authorization request submitted on behalf of Min-Jee Park (member ID ANTH-W123456789) for MRI Lumbar Spine without contrast has been approved.

The determination was rendered under Magnetic Resonance Imaging — Lumbar Spine (Anthem Medical Policy RAD.00029, effective 2026-01-01). All 5 medical-necessity criteria were evaluated against the submitted clinical evidence.

Clinical rationale: Symptom duration ≥6 weeks (✓), failed conservative therapy with PT + NSAIDs (✓), focal neuro exam findings consistent with L5 radiculopathy (✓), no recent equivalent imaging (✓), credentialed PCP order (✓). Determination meets all elements of Anthem RAD.00029. Auto-approval issued under policy; member entitled to 90-day authorization window.