NY State Workers' Comp Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267), for workers_comp plans. Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267). Confirm with NY State Workers' Comp, as this can vary by plan.
Medical-necessity criteria NY State Workers' Comp generally applies
Decompression-alone (laminotomy/facetectomy/laminectomy) is NOT on the 324.3 always-PA list (unlike fusion). Authorized when consistent with the NY WC Mid and Low Back / Neck Injury MTG — symptomatic stenosis with neurogenic claudication or radiculopathy that failed conservative care, confirmed on concordant imaging. File an MTG Variance via OnBoard only if out-of-guideline.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures. Confirm the covered diagnosis list against the current NY State Workers' Comp policy.
How to submit
- Method: OnBoard PAR
- Portal: NY WCB OnBoard
Sources & verification
- BindingSource — NY WCB Mid and Low Back Injury Medical Treatment Guidelines · effective 2022-05-02.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 NY State Workers' Comp require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267). Confirm with NY State Workers' Comp, as this can vary by plan.
What does NY State Workers' Comp require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Decompression-alone (laminotomy/facetectomy/laminectomy) is NOT on the 324.3 always-PA list (unlike fusion). Authorized when consistent with the NY WC Mid and Low Back / Neck Injury MTG — symptomatic stenosis with neurogenic claudication or radiculopathy that failed conservative care, confirmed on concordant imaging. File an MTG Variance via OnBoard only if out-of-guideline. Always confirm against the current NY State Workers' Comp policy.
How long does a NY State Workers' Comp prior authorization take?
Turnaround varies by plan and submission method. Check the NY State Workers' Comp portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to NY State Workers' Comp?
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.