QualCare Pain Management Procedures prior authorization requirements (2026)
What QualCare 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. QualCare 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 QualCare generally applies
Prior authorization via eviCore (Cigna interventional pain program). Facet interventions governed by Cigna policy 0525 and eviCore CMM-201 (facet injections/medial-branch blocks) and CMM-208 (ablation/denervation): diagnostic medial-branch-block confirmation precedes radiofrequency ablation, and repeat RFA at the same level is medically necessary only when at least 6 months have elapsed since the prior ablation and response criteria are met. Governed by Cigna policy 0525, eviCore CMM-201/CMM-208.
How to submit
- Method: eviCore portal
- Portal: eviCore by Evernorth (Cigna MSK/Spine)
Sources & verification
- BindingSource — Cigna Medical Coverage Policy 0525 — Peripheral Nerve Destruction (facet ablation), with eviCore CMM-201/CMM-208 (0525).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 QualCare require prior authorization for Pain Management Procedures?
Yes. QualCare 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 QualCare require to approve Pain Management Procedures?
Prior authorization via eviCore (Cigna interventional pain program). Facet interventions governed by Cigna policy 0525 and eviCore CMM-201 (facet injections/medial-branch blocks) and CMM-208 (ablation/denervation): diagnostic medial-branch-block confirmation precedes radiofrequency ablation, and repeat RFA at the same level is medically necessary only when at least 6 months have elapsed since the … Always confirm against the current QualCare policy.
How long does a QualCare prior authorization take?
Turnaround varies by plan and submission method. Check the QualCare portal for current timeframes.
Submitting Pain Management Procedures to QualCare?
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.