Why does Cigna want me to do physical therapy before an MRI?

The imaging criteria applied to most spine and joint MRI requests expect a documented trial of conservative treatment, often around six weeks, unless red-flag findings are present. It is a coverage rule, not a clinical opinion about you. If you already completed that treatment, the problem is usually that the dates and outcomes are not in the submitted records.

What is a peer-to-peer review and should I ask for one?

It is a direct conversation between your ordering physician and the reviewing physician. Yes — it is usually faster than a written appeal and it lets your doctor explain specifics a checklist cannot capture. Ask the ordering office to request it as soon as the denial arrives, and confirm they actually scheduled it.

Can I just pay cash for the MRI instead?

You can, and cash prices at freestanding imaging centers are sometimes lower than people expect. But money paid outside your benefit generally will not count toward your deductible or out-of-pocket maximum, and paying cash can end the appeal. If you might still want coverage, ask about the cost first and keep the appeal running.

Guides · Cigna · appeals · Updated August 2026

How to appeal a Cigna MRI or imaging denial

If Cigna denied advanced imaging, the decision very likely did not come from Cigna. It came from a radiology benefit manager applying a checklist to your chart — and that checklist usually asks one question: did you try conservative treatment first, and is it documented.

Why Cigna denies this

Cigna routes advanced imaging prior authorization through eviCore, a radiology benefit manager that applies proprietary imaging criteria. The typical denial for spine or joint MRI says conservative treatment was not tried or not documented for long enough — commonly a six-week expectation of physical therapy, medication, or activity modification before imaging is approved. For PET and advanced oncologic imaging, denials usually cite the stage, indication, or interval since the last scan. Two things matter here. First, a peer-to-peer review, where your ordering physician speaks directly with the reviewing physician, resolves a large share of these before a written appeal is ever needed, and it can often be scheduled within days. Second, red-flag findings are supposed to bypass the conservative-care requirement entirely — but only if they are written in the chart.

What wins the appeal

Ask your ordering physician to request a peer-to-peer review first, and ask the office to note the reviewer's name and specialty. In parallel, gather documentation of conservative care with dates: physical therapy visit notes and duration, medications tried and for how long, injections, and objective findings on exam. If any red flags exist — progressive neurological deficit, suspected malignancy, unexplained weight loss, fever with back pain, trauma, or failure to improve after documented conservative treatment — make sure they appear explicitly in the note, because reviewers are looking for those exact words. Request the specific imaging criteria applied to your case in writing, along with the reviewing physician's specialty; a reviewer without relevant specialty training is itself an appeal argument. Commercial Cigna appeals generally allow 180 days from the denial notice, and if the delay itself threatens your health, request an expedited review for a decision in roughly 72 hours.

Your deadline

Depends on your plan type: 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, and only 65 for Medicare Advantage. Set it before you do anything else.

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Common questions

Why does Cigna want me to do physical therapy before an MRI?: The imaging criteria applied to most spine and joint MRI requests expect a documented trial of conservative treatment, often around six weeks, unless red-flag findings are present. It is a coverage rule, not a clinical opinion about you. If you already completed that treatment, the problem is usually that the dates and outcomes are not in the submitted records.
What is a peer-to-peer review and should I ask for one?: It is a direct conversation between your ordering physician and the reviewing physician. Yes — it is usually faster than a written appeal and it lets your doctor explain specifics a checklist cannot capture. Ask the ordering office to request it as soon as the denial arrives, and confirm they actually scheduled it.
Can I just pay cash for the MRI instead?: You can, and cash prices at freestanding imaging centers are sometimes lower than people expect. But money paid outside your benefit generally will not count toward your deductible or out-of-pocket maximum, and paying cash can end the appeal. If you might still want coverage, ask about the cost first and keep the appeal running.