Sedgwick Pain Injections - Spine prior authorization requirements (2026)
What Sedgwick generally requires to approve Pain Injections - Spine (CPT 62281, 62291, 62292). Yes. Sedgwick generally requires prior authorization for Pain Injections - Spine (CPT 62281, 62291, 62292).
Medical-necessity criteria Sedgwick generally applies
Sedgwick/ODG WC: (1) Work-related diagnosis with imaging correlation; (2) ODG criteria for injection type and frequency met; (3) Treating WC physician ordering; (4) ODG frequency limits: 3 per spinal region per year; (5) Prior injection response documented (functional improvement toward RTW); (6) NCM informed of injection plan for complex cases
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Pain Injections - Spine. Confirm the covered diagnosis list against the current Sedgwick policy.
Commonly required documentation
- Work injury records
- MRI/CT
- treating physician order
- PT records
- prior injection response with functional metrics
- ODG compliance documentation
How to submit
- Portal: mySedgwick Provider Portal
- Typical turnaround: about 3 days
Source
Sedgwick uses MDGuidelines (ODG) for all UR decisions. Injections must demonstrate functional improvement and RTW progress. Contact claim adjuster for cases where ODG thresholds are reached to discuss further authorization.
Frequently asked questions
Does Sedgwick require prior authorization for Pain Injections - Spine?
Yes. Sedgwick generally requires prior authorization for Pain Injections - Spine (CPT 62281, 62291, 62292).
What does Sedgwick require to approve Pain Injections - Spine?
Sedgwick/ODG WC: (1) Work-related diagnosis with imaging correlation; (2) ODG criteria for injection type and frequency met; (3) Treating WC physician ordering; (4) ODG frequency limits: 3 per spinal region per year; (5) Prior injection response documented (functional improvement toward RTW); (6) NCM informed of injection plan for complex cases Always confirm against the current Sedgwick policy.
How long does a Sedgwick prior authorization take?
Sedgwick typically decides Pain Injections - Spine requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Pain Injections - Spine to Sedgwick?
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.