Priority Health Pain Management Procedures prior authorization requirements (2026)
What Priority 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. Prior authorization requirements vary by plan. Confirm with Priority Health 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 Priority Health generally applies
Interventional pain is NOT in the TurningPoint (surgical) program and NOT eviCore (which dropped spine/joint 4/5/2021) — it is handled IN-HOUSE under Priority Health medical policies; the procedure-level auth-required code list was not retrievable at sourcing, so PA status is unconfirmed (verify in prism Authorization Criteria Lookup). DOCUMENTED criteria for radiofrequency ablation (Policy 91647-R1 "Neuroablation for Pain Management," eff. 3/1/2026): conventional RFA (60-90 C) medically necessary when pain is not from disc herniation/spondylolisthesis/stenosis, no neurologic deficit, axial pain predominates, AND two diagnostic medial-branch blocks (alternating anesthetic) give over 50% relief. Cooled RFA, pulsed RFA, cryoneurolysis, and SI-joint/sacral RFA are experimental/not medically necessary. Basivertebral nerve ablation (Intracept) covered with its own criteria (L3-S1, 6+ months chronic LBP failing 6+ months conservative care, Type 1/2 Modic changes).
How to submit
- Method: Priority Health prism (in-house UM)
- Portal: Priority Health prism
Sources & verification
- BindingSource — Medical Policy 91647-R1 — Neuroablation for Pain Management (91647-R1) · effective 2026-03-01.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 Priority Health require prior authorization for Pain Management Procedures?
Prior authorization requirements vary by plan. Confirm with Priority Health 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 Priority Health require to approve Pain Management Procedures?
Interventional pain is NOT in the TurningPoint (surgical) program and NOT eviCore (which dropped spine/joint 4/5/2021) — it is handled IN-HOUSE under Priority Health medical policies; the procedure-level auth-required code list was not retrievable at sourcing, so PA status is unconfirmed (verify in prism Authorization Criteria Lookup). DOCUMENTED criteria for radiofrequency ablation (Policy 91647-… Always confirm against the current Priority Health policy.
How long does a Priority Health prior authorization take?
Turnaround varies by plan and submission method. Check the Priority Health portal for current timeframes.
Submitting Pain Management Procedures to Priority 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.