Oscar Health Pain Management Procedures prior authorization requirements (2026)
What Oscar Health 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 commercial plans. Yes. Oscar Health generally requires 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).
Medical-necessity criteria Oscar Health generally applies
Interventional pain requires prior authorization via eviCore (CMM-200 ESI / CMM-201 facet / CMM-208 ablation): 6 weeks conservative care before ESI, 4 weeks before facet/SI injections, two medial-branch blocks with at least 80% relief before RFA; fluoroscopic/CT guidance required.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — Oscar — eviCore Musculoskeletal/Spine/Pain program.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 Oscar Health require prior authorization for Pain Management Procedures?
Yes. Oscar Health generally requires 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).
What does Oscar Health require to approve Pain Management Procedures?
Interventional pain requires prior authorization via eviCore (CMM-200 ESI / CMM-201 facet / CMM-208 ablation): 6 weeks conservative care before ESI, 4 weeks before facet/SI injections, two medial-branch blocks with at least 80% relief before RFA; fluoroscopic/CT guidance required. Always confirm against the current Oscar Health policy.
How long does a Oscar Health prior authorization take?
Turnaround varies by plan and submission method. Check the Oscar Health portal for current timeframes.
Submitting Pain Management Procedures to Oscar Health?
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.