NY State Workers' Comp Pain Management Procedures prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260), for workers_comp plans. Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260). Confirm with NY State Workers' Comp, as this can vary by plan.
Medical-necessity criteria NY State Workers' Comp generally applies
Epidural/facet injections and radiofrequency ablation are authorized when consistent with the NY WC Back/Non-Acute Pain MTG within frequency limits (ESI fluoroscopically guided for radicular pain; RFA only after two successful diagnostic medial-branch blocks; not more than three facet joints). Beyond MTG limits, file an MTG Variance via OnBoard.
How to submit
- Method: OnBoard PAR
- Portal: NY WCB OnBoard
Sources & verification
- BindingSource — NY WCB Non-Acute Pain 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 2026-06-25.
Frequently asked questions
Does NY State Workers' Comp require prior authorization for Pain Management Procedures?
Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Pain Management Procedures (CPT 27096, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0259, G0260). Confirm with NY State Workers' Comp, as this can vary by plan.
What does NY State Workers' Comp require to approve Pain Management Procedures?
Epidural/facet injections and radiofrequency ablation are authorized when consistent with the NY WC Back/Non-Acute Pain MTG within frequency limits (ESI fluoroscopically guided for radicular pain; RFA only after two successful diagnostic medial-branch blocks; not more than three facet joints). Beyond MTG limits, file an MTG Variance via OnBoard. 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 Pain Management 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.