Braven Health Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What Braven Health 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 medicare_advantage plans. Yes. Braven Health 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 Braven Health generally applies
Prior authorization via TurningPoint Spine Services (cervical/thoracic/lumbar laminectomy, discectomy, laminotomy, decompression — CPT 63001-63048). Conservative-care and imaging thresholds in the TurningPoint policy library. [NEEDS CLINICAL SPOT-CHECK]
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 Braven Health policy.
How to submit
- Method: TurningPoint (Availity / portal / 1-833-436-4083)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Surgical & Implantable Device Management Program — Spine Services (procedure-code list incl. laminectomy/discectomy, cervical & lumbar disc replacement, vertebral augmentation).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 Braven Health require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Yes. Braven Health 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 Braven Health require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Prior authorization via TurningPoint Spine Services (cervical/thoracic/lumbar laminectomy, discectomy, laminotomy, decompression — CPT 63001-63048). Conservative-care and imaging thresholds in the TurningPoint policy library. [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to Braven Health?
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.