Braven Health Epidural Steroid Injection (interlaminar / transforaminal) prior authorization requirements (2026)
What Braven Health generally requires to approve Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
Medical-necessity criteria Braven Health generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior Authorization / Medical Necessity Determination (PA/MND) IS REQUIRED. Braven Health Medicare Advantage plans are named EXPLICITLY and verbatim in the list of "Members included in this program" on Horizon's "Musculoskeletal Program for Pain Management Services" page (fetched 2026-08-07), which delegates interventional pain review to eviCore. The Horizon pain-management code list in scope includes 62320-62327 and 64479, 64480, 64483, 64484 — covering every CPT code on this procedure row. BINDING CLINICAL CRITERIA: the eviCore "Musculoskeletal: Advanced Procedures" guidelines hosted in the eviCore Provider's Hub. Praxigen did NOT retrieve the Braven/Horizon-specific eviCore guideline document; NO numeric threshold (conservative-care duration, injections per episode or per 12 months, repeat-response percentage) is asserted here. Verify the guideline in force on the date of service. MEDICARE OVERLAY: as a Medicare Advantage plan, Braven must also cover no less than Original Medicare. Praxigen did NOT verify on 2026-08-07 which Novitas (JL) epidural LCD version is being applied to Braven determinations, so no LCD number is asserted on this row.
Commonly required documentation
- Clinical documentation supporting the eviCore Musculoskeletal: Advanced Procedures criteria in force on the date of service. SEPARATE PA/MND IS REQUIRED FOR ANESTHESIA performed in conjunction with a musculoskeletal pain management procedure — Horizon states claims for that anesthesia "will not be paid if there a valid authorization is not on file."
How to submit
- Method: Submit online through eviCore.com, or call 1-866-241-6603 between 7 a.m. and 7 p.m. Eastern Time (per the Horizon program page that names Braven).
- Portal: eviCore by Evernorth (Horizon/Braven Musculoskeletal Pain Management Program)
Sources & verification
- BindingSource — Musculoskeletal Program for Pain Management Services — "Members included in this program" names Braven Health Medicare Advantage plans.View
- BindingSource — Pain Management Procedure Codes (codes requiring PA/MND under the eviCore MSK pain program).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 2026-08-07.
Frequently asked questions
Does Braven Health require prior authorization for Epidural Steroid Injection (interlaminar / transforaminal)?
Yes. Braven Health generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
What does Braven Health require to approve Epidural Steroid Injection (interlaminar / transforaminal)?
[NEEDS CLINICAL SPOT-CHECK] Prior Authorization / Medical Necessity Determination (PA/MND) IS REQUIRED. Braven Health Medicare Advantage plans are named EXPLICITLY and verbatim in the list of "Members included in this program" on Horizon's "Musculoskeletal Program for Pain Management Services" page (fetched 2026-08-07), which delegates interventional pain review to eviCore. The Horizon pain-manage… 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 Epidural Steroid Injection (interlaminar / transforaminal) 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.