NY State Workers' Comp Facet Joint Injection / Medial Branch Block prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Facet Joint Injection / Medial Branch Block (CPT 64490, 64491, 64492, 64493, 64494, 64495), for Workers Compensation (NY) plans. Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Facet Joint Injection / Medial Branch Block (CPT 64490, 64491, 64492, 64493, 64494, 64495). Confirm with NY State Workers' Comp, as this can vary by plan.
Medical-necessity criteria NY State Workers' Comp generally applies
Same NY WCB Medical Treatment Guidelines framework as other spine injections: MTG-consistent care for a covered body part needs NO prior authorization; a Variance PAR is required to exceed guideline duration/frequency or to depart from the standard. Facet interventions for work-related neck or back injury fall under the Neck Injury and Mid and Low Back Injury MTGs and the Non-Acute Pain MTG. PER-PROCEDURE MTG THRESHOLDS NOT YET EXTRACTED - do not assume the Medicare LCD numbers (80% diagnostic relief, two blocks before RFA, 4 sessions per region per year) carry over; the WCB guidelines are a separate standard and may differ. [NEEDS CLINICAL SPOT-CHECK - framework sourced, thresholds pending]
Commonly required documentation
- Documentation establishing MTG consistency
- objective functional improvement for continued care
- variance rationale where the request exceeds the guideline.
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 8 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 Facet Joint Injection / Medial Branch Block?
Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Facet Joint Injection / Medial Branch Block (CPT 64490, 64491, 64492, 64493, 64494, 64495). Confirm with NY State Workers' Comp, as this can vary by plan.
What does NY State Workers' Comp require to approve Facet Joint Injection / Medial Branch Block?
Same NY WCB Medical Treatment Guidelines framework as other spine injections: MTG-consistent care for a covered body part needs NO prior authorization; a Variance PAR is required to exceed guideline duration/frequency or to depart from the standard. Facet interventions for work-related neck or back injury fall under the Neck Injury and Mid and Low Back Injury MTGs and the Non-Acute Pain MTG. PER-P… 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 Facet Joint Injection / Medial Branch Block requests in about 8 days. Timeframes vary; check the payer portal.
Submitting Facet Joint Injection / Medial Branch Block 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.