Prior authorization approved

This letter confirms that the prior-authorization request submitted on behalf of Aiko Ito (member ID ANTH-330887119) for Cardiac MRI with stress perfusion 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: Initial reviewer cited 'alternative imaging' as missing; appeal demonstrated nuclear stress was inconclusive and ACC AUC supports MRI as next step. Approved.