Clover Health Epidural Steroid Injection (interlaminar / transforaminal) prior authorization requirements (2026)
What Clover Health generally requires to approve Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484), for medicare_advantage plans. Yes. Clover Health generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
Medical-necessity criteria Clover Health generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior authorization IS REQUIRED and is DELEGATED TO eviCore. The eviCore "Clover Health Provider Resources" page (fetched 2026-08-07) lists "Musculoskeletal — Interventional Pain, Spine and Joint Surgery" among the solutions eviCore manages for Clover Health, effective 2020-08-01, alongside Advanced Imaging, Cardiac Imaging, Radiation Therapy, Sleep and Peripheral Vascular Intervention (PVI, effective 2025-11-01). BINDING CLINICAL CRITERIA: the eviCore interventional-pain guideline set applicable to Clover Health. Praxigen did NOT retrieve the Clover-specific eviCore guideline document on 2026-08-07, so NO numeric threshold is asserted on this row. CROSS-CHECK NOTE: the existing Praxigen row for Clover x "Pain Management Procedures" (requirement 539, last verified 2026-06-25) asserts 6 weeks of conservative care before an epidural steroid injection, 4 weeks before facet/medial-branch or SI-joint injections, two diagnostic medial-branch blocks with at least 80% relief before radiofrequency ablation, and ESI limited to 3 per episode and 4 per 12 months, citing an eviCore Clover Interventional Pain FAQ plus Novitas LCDs L36920 and L34892. Those thresholds were NOT re-verified in this batch and are therefore deliberately NOT restated here. A reviewer should re-confirm them before they are relied on for either procedure row.
Commonly required documentation
- Clinical documentation supporting the eviCore interventional-pain criteria in force on the date of service. eviCore requires a separate pre-service authorization request per date of service for interventional pain procedures — confirm on the current Clover program materials before batching multiple dates.
How to submit
- Method: Submit prior authorization through the eviCore provider portal.
- Portal: eviCore by Evernorth (Clover Health MSK / Interventional Pain program)
Sources & verification
- BindingSource — Clover Health Provider Resources — solutions managed for Clover Health, incl. Musculoskeletal (Interventional Pain, Spine and Joint Surgery).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 Clover Health require prior authorization for Epidural Steroid Injection (interlaminar / transforaminal)?
Yes. Clover Health generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
What does Clover Health require to approve Epidural Steroid Injection (interlaminar / transforaminal)?
[NEEDS CLINICAL SPOT-CHECK] Prior authorization IS REQUIRED and is DELEGATED TO eviCore. The eviCore "Clover Health Provider Resources" page (fetched 2026-08-07) lists "Musculoskeletal — Interventional Pain, Spine and Joint Surgery" among the solutions eviCore manages for Clover Health, effective 2020-08-01, alongside Advanced Imaging, Cardiac Imaging, Radiation Therapy, Sleep and Peripheral Vascu… Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting Epidural Steroid Injection (interlaminar / transforaminal) to Clover 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.