AIM (out-of-state / Federal BCBS) Pain Management Procedures prior authorization requirements (2026)
What AIM (out-of-state / Federal BCBS) generally requires to approve Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260), for commercial plans. Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260).
Medical-necessity criteria AIM (out-of-state / Federal BCBS) generally applies
Prior authorization via Carelon. Diagnostic medial-branch blocks: positive equals at least 80% relief of index pain; DUAL blocks on two separate occasions (at least 1 week apart) are required before radiofrequency neurotomy; at least 6 weeks conservative management. RFN: requires the dual 80%-relief blocks within the prior 6 months; REPEAT RFN only with at least 50% relief plus ADL improvement sustained at least 6 months, no more than twice/year per level. Epidural steroid injections (62321-62323): at least 4 weeks conservative management (2 weeks if clear radiculopathy), MRI/CT within 18 months; repeat requires prior at least 50% pain reduction plus functional improvement for at least 3 months; max 4 therapeutic sessions/12 months/region. Carelon Interventional Pain MSK01-0626.1.
How to submit
- Method: Carelon ProviderPortal
- Portal: Carelon Medical Benefits Management
Sources & verification
- BindingSource — Carelon Clinical Appropriateness Guidelines — Interventional Pain Management (MSK01-0626.1) · effective 2026-06-14.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 Pain Management Procedures?
Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260).
What does AIM (out-of-state / Federal BCBS) require to approve Pain Management Procedures?
Prior authorization via Carelon. Diagnostic medial-branch blocks: positive equals at least 80% relief of index pain; DUAL blocks on two separate occasions (at least 1 week apart) are required before radiofrequency neurotomy; at least 6 weeks conservative management. RFN: requires the dual 80%-relief blocks within the prior 6 months; REPEAT RFN only with at least 50% relief plus ADL improvement sus… 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 Pain Management 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.