Braven Health Pain Management Procedures prior authorization requirements (2026)
What Braven Health 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 medicare_advantage plans. Yes. Braven Health 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 Braven Health generally applies
Prior authorization required — interventional pain (epidural/facet/medial-branch/RFA/SI-joint injections) runs through eviCore's Musculoskeletal Pain Management program, Braven explicitly in scope. Documented: fluoroscopic or CT image guidance required; epidural steroid injections limited to 3 per episode and 4 per 12-month period; subsequent injections require documented response (VAS improvement, functional gain) to prior injections; radiculopathy supported by objective exam findings or concordant EMG/imaging. A separate PA is required for anesthesia for pain procedures.
How to submit
- Method: eviCore (eviCore.com / 1-866-241-6603)
- Portal: eviCore by Evernorth
Sources & verification
- BindingSource — Musculoskeletal Program for Pain Management Services (eviCore; Braven in scope).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 Pain Management Procedures?
Yes. Braven Health 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 Braven Health require to approve Pain Management Procedures?
Prior authorization required — interventional pain (epidural/facet/medial-branch/RFA/SI-joint injections) runs through eviCore's Musculoskeletal Pain Management program, Braven explicitly in scope. Documented: fluoroscopic or CT image guidance required; epidural steroid injections limited to 3 per episode and 4 per 12-month period; subsequent injections require documented response (VAS improvement… 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 Pain Management 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.