Clover Health Pain Management Procedures prior authorization requirements (2026)
What Clover 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. Clover 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 Clover Health generally applies
Interventional pain requires prior authorization via eviCore, per date of service: 6 weeks 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; ESI limited to 3 per episode and 4 per 12 months. In NJ, Novitas LCDs L36920 (ESI) and L34892 (facet) also govern.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — Clover Health — Interventional Pain, Spine and Joint Surgeries FAQ (eviCore).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 2026-06-25.
Frequently asked questions
Does Clover Health require prior authorization for Pain Management Procedures?
Yes. Clover 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 Clover Health require to approve Pain Management Procedures?
Interventional pain requires prior authorization via eviCore, per date of service: 6 weeks 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; ESI limited to 3 per episode and 4 per 12 months. In NJ, Novitas LCDs L36920 (ESI) and L34892 (facet)… 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 Pain Management Procedures 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.