Horizon BCBS NJ Epidural Steroid Injection (interlaminar / transforaminal) prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484), for commercial plans. Yes. Horizon BCBS NJ generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
Medical-necessity criteria Horizon BCBS NJ generally applies
[NEEDS CLINICAL SPOT-CHECK] Prior Authorization / Medical Necessity Determination (PA/MND) IS REQUIRED and is DELEGATED BY HORIZON TO eviCore under the Horizon "Musculoskeletal Program for Pain Management Services". Horizon's published pain-management procedure code list includes the epidural codes 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 and the transforaminal codes 64479, 64480, 64483 and 64484 — i.e. every CPT code on this procedure row is in scope. MEMBERS INCLUDED IN THIS PROGRAM (verbatim from the Horizon program page, 2026-08-07): "Horizon fully insured or level-funded plans/products including those members enrolled in Horizon BCBSNJ plans that include BlueCard benefits for care received outside of our local service area"; "Braven Health Medicare Advantage plans"; "State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) employer group plans"; "Certain Administrative Services Only (ASO) employer group accounts that have opted-in to this program". BINDING CLINICAL CRITERIA: Horizon states verbatim that "EviCore hosts the clinical guidelines that support the PA/MND reviews they perform as part of this program" and directs providers to "Musculoskeletal: Advanced Procedures" within the eviCore Provider's Hub. Praxigen did NOT retrieve the Horizon-specific eviCore guideline document, so NO conservative-care duration, injection-count cap, or repeat-response threshold is asserted here. Verify the eviCore Musculoskeletal: Advanced Procedures guideline in force on the date of service before relying on any numeric limit.
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 — Horizon states verbatim: "Anesthesia services performed in conjunction with musculoskeletal pain management procedures require separate PA/MND. Claims submitted for anesthesia services related to a pain management procedure 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).
- Portal: eviCore by Evernorth (Horizon Musculoskeletal Pain Management Program)
Sources & verification
- BindingSource — Musculoskeletal Program for Pain Management Services.View
- BindingSource — Pain Management Procedure Codes (list of Musculoskeletal Pain Management procedure codes that require PA/MND).View
- BindingSource — Horizon Provider Resources (eviCore program list for Horizon BCBSNJ).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 Horizon BCBS NJ require prior authorization for Epidural Steroid Injection (interlaminar / transforaminal)?
Yes. Horizon BCBS NJ generally requires prior authorization for Epidural Steroid Injection (interlaminar / transforaminal) (CPT 62321, 62323, 64479, 64480, 64483, 64484).
What does Horizon BCBS NJ require to approve Epidural Steroid Injection (interlaminar / transforaminal)?
[NEEDS CLINICAL SPOT-CHECK] Prior Authorization / Medical Necessity Determination (PA/MND) IS REQUIRED and is DELEGATED BY HORIZON TO eviCore under the Horizon "Musculoskeletal Program for Pain Management Services". Horizon's published pain-management procedure code list includes the epidural codes 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 and the transforaminal codes 64479, 64480,… Always confirm against the current Horizon BCBS NJ policy.
How long does a Horizon BCBS NJ prior authorization take?
Turnaround varies by plan and submission method. Check the Horizon BCBS NJ portal for current timeframes.
Submitting Epidural Steroid Injection (interlaminar / transforaminal) to Horizon BCBS NJ?
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.