TRICARE Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What TRICARE generally requires to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267), for tricare plans. Based on the cited policy, TRICARE does not generally require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267). Confirm with TRICARE, as this can vary by plan.
Medical-necessity criteria TRICARE generally applies
Open laminectomy/decompression is a covered benefit (TPM Ch 4 Sec 20.1, Nervous System) under the general medical-necessity standard — no decompression-specific TRICARE criteria. Prior authorization is administrative: TRICARE Prime needs a PCM referral and inpatient admissions require pre-authorization; TRICARE Select generally needs no referral.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures. Confirm the covered diagnosis list against the current TRICARE policy.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 20.1 (Nervous System) · effective 2017-03-10.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 TRICARE require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Based on the cited policy, TRICARE does not generally require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267). Confirm with TRICARE, as this can vary by plan.
What does TRICARE require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Open laminectomy/decompression is a covered benefit (TPM Ch 4 Sec 20.1, Nervous System) under the general medical-necessity standard — no decompression-specific TRICARE criteria. Prior authorization is administrative: TRICARE Prime needs a PCM referral and inpatient admissions require pre-authorization; TRICARE Select generally needs no referral. Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to TRICARE?
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.