AIM (out-of-state / Federal BCBS) Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What AIM (out-of-state / Federal BCBS) generally requires to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267), for commercial plans. Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267).
Medical-necessity criteria AIM (out-of-state / Federal BCBS) generally applies
Prior authorization via Carelon (Spine Surgery MSK03-1125.1-UC0126). Lumbar decompression: radicular pain with correlating exam OR progressive/severe deficit (cauda equina/lateral-recess/foraminal); minimum 6 weeks conservative care (waived for progressive deficit/cauda equina); advanced imaging within 9 months showing concordant nerve-root/thecal-sac compression. Cervical decompression: radiculopathy needs objective findings or a 6-week trial; myelopathy needs clinical signs; multilevel stenosis requires neutral-to-lordotic alignment (kyphosis 13 degrees or less).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures. Confirm the covered diagnosis list against the current AIM (out-of-state / Federal BCBS) policy.
How to submit
- Method: Carelon ProviderPortal
- Portal: Carelon Medical Benefits Management
Sources & verification
- BindingSource — Carelon Clinical Appropriateness Guidelines — Spine Surgery (MSK03-1125.1-UC0126) · effective 2026-01-01.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does AIM (out-of-state / Federal BCBS) require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267).
What does AIM (out-of-state / Federal BCBS) require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Prior authorization via Carelon (Spine Surgery MSK03-1125.1-UC0126). Lumbar decompression: radicular pain with correlating exam OR progressive/severe deficit (cauda equina/lateral-recess/foraminal); minimum 6 weeks conservative care (waived for progressive deficit/cauda equina); advanced imaging within 9 months showing concordant nerve-root/thecal-sac compression. Cervical decompression: radiculop… Always confirm against the current AIM (out-of-state / Federal BCBS) policy.
How long does a AIM (out-of-state / Federal BCBS) prior authorization take?
Turnaround varies by plan and submission method. Check the AIM (out-of-state / Federal BCBS) portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to AIM (out-of-state / Federal BCBS)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.