NY State Workers' Comp DRG Stimulation (Dorsal Root Ganglion) prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve DRG Stimulation (Dorsal Root Ganglion) (CPT 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971), for Workers Compensation (NY) plans. Yes. NY State Workers' Comp generally requires prior authorization for DRG Stimulation (Dorsal Root Ganglion) (CPT 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971).
Medical-necessity criteria NY State Workers' Comp generally applies
PRIOR AUTHORIZATION IS ALWAYS REQUIRED, on the same basis as spinal cord stimulation: DRG stimulation is an implanted spinal neurostimulator and falls within the NY WCB "Special Services" category that always requires pre-authorization. Submit a Special Services PAR through OnBoard; carrier response deadline is 30 calendar days. Where the claim is for lower-extremity CRPS, the CRPS MTG is also in play alongside the Non-Acute Pain MTG. [NEEDS CLINICAL SPOT-CHECK - Special Services listing sourced by analogy to spinal cord stimulators, which are named explicitly; confirm DRG is treated identically by the carrier]
Commonly required documentation
- Special Services PAR with CRPS or other qualifying diagnosis, failed prior modalities, psychological evaluation, and trial results.
How to submit
- Method: Submit through OnBoard, the WCB online system, via the Medical Portal using Board-assigned NY.gov credentials. Paper/fax PARs are not the pathway.
- Portal: OnBoard (NYS WCB Medical Portal)
- Typical turnaround: about 30 days
Sources & verification
- BindingSource — Medical Treatment Guidelines - overview, PAR types and response deadlines (MTG Confirmation 8 business days; Variance 30 calendar days; Special Services 30 calendar days) · 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 2026-08-10.
Frequently asked questions
Does NY State Workers' Comp require prior authorization for DRG Stimulation (Dorsal Root Ganglion)?
Yes. NY State Workers' Comp generally requires prior authorization for DRG Stimulation (Dorsal Root Ganglion) (CPT 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, 95971).
What does NY State Workers' Comp require to approve DRG Stimulation (Dorsal Root Ganglion)?
PRIOR AUTHORIZATION IS ALWAYS REQUIRED, on the same basis as spinal cord stimulation: DRG stimulation is an implanted spinal neurostimulator and falls within the NY WCB "Special Services" category that always requires pre-authorization. Submit a Special Services PAR through OnBoard; carrier response deadline is 30 calendar days. Where the claim is for lower-extremity CRPS, the CRPS MTG is also in … Always confirm against the current NY State Workers' Comp policy.
How long does a NY State Workers' Comp prior authorization take?
NY State Workers' Comp typically decides DRG Stimulation (Dorsal Root Ganglion) requests in about 30 days. Timeframes vary; check the payer portal.
Submitting DRG Stimulation (Dorsal Root Ganglion) 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.