Horizon BCBS NJ Pain Injections - Spine prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve Pain Injections - Spine (CPT 62281, 62291, 62292), for PPO plans. Yes. Horizon BCBS NJ generally requires prior authorization for Pain Injections - Spine (CPT 62281, 62291, 62292).
Medical-necessity criteria Horizon BCBS NJ generally applies
Prior authorization required; managed by eviCore (EviCore by Evernorth) under Horizon's Musculoskeletal Program for Pain Management Services (NOT TurningPoint, which handles surgical ortho/spine; NOT Carelon). Coverage differs by code. Discography (62291, cervical/thoracic; note 62290 is the lumbar discography code) is medically necessary per Horizon Policy 056 (Discography) when all are met: no red-flag conditions; failed conservative treatment for at least 6 weeks; clinical presentation consistent with disc disease; imaging showing disc damage (annular tears, contained herniation, or high-intensity zones); and performed in coordination with a surgeon who may perform a subsequent therapeutic procedure (both surgeon and supervising radiologist involved). Chemonucleolysis (62292) is inclusive with discography and not separately medically necessary. Functional anesthetic discography is investigational. Epidural neurolytic injection (62281) is in eviCore's interventional-pain scope; a Horizon-specific medical-necessity policy for 62281 was not located [NEEDS VERIFICATION]. CPT descriptors: 62290 = lumbar discography, 62291 = cervical/thoracic discography, 62292 = chemonucleolysis (incl. discography), 62281 = epidural neurolytic (lumbar/sacral) - confirm the stored code set against the AMA CPT codebook.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Pain Injections - Spine. Confirm the covered diagnosis list against the current Horizon BCBS NJ policy.
Related procedure codes
Codes often billed alongside Pain Injections - Spine: 62281, 62291, 62292. Verify the correct codes for your documentation.
Commonly required documentation
- Clinical records demonstrating failed conservative care (at least 6 weeks), imaging findings of disc damage, and surgical-planning coordination (for discography). eviCore requires the full clinical packet at the time of request.
Situations to verify before submitting
Horizon BCBS NJ may not cover Pain Injections - Spine in these situations. Verify against the current policy rather than assuming a denial:
- Functional anesthetic discography (investigational) - Horizon Policy 056
- Chemonucleolysis (62292) billed separately - inclusive with discography, not separately medically necessary - Horizon Policy 056
- Diagnostic discography without concurrent surgical/discectomy planning, or without both surgeon and supervising radiologist involvement - not medically necessary
How to submit
- Method: portal
- Portal: eviCore (EviCore by Evernorth) Provider Portal
Sources & verification
- BindingPayer medical policy — Horizon Policy 056 - Discography (056) · effective 2018-10-22.View
- Portal-onlyeviCore — Horizon Musculoskeletal Program for Pain Management Services (eviCore / EviCore by Evernorth).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 2026-06-19.
Frequently asked questions
Does Horizon BCBS NJ require prior authorization for Pain Injections - Spine?
Yes. Horizon BCBS NJ generally requires prior authorization for Pain Injections - Spine (CPT 62281, 62291, 62292).
What does Horizon BCBS NJ require to approve Pain Injections - Spine?
Prior authorization required; managed by eviCore (EviCore by Evernorth) under Horizon's Musculoskeletal Program for Pain Management Services (NOT TurningPoint, which handles surgical ortho/spine; NOT Carelon). Coverage differs by code. Discography (62291, cervical/thoracic; note 62290 is the lumbar discography code) is medically necessary per Horizon Policy 056 (Discography) when all are met: no r… 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 Pain Injections - Spine 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.