TRICARE Pain Management Procedures prior authorization requirements (2026)
What TRICARE 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 tricare plans. Based on the cited policy, TRICARE does not generally require 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). Confirm with TRICARE, as this can vary by plan.
Medical-necessity criteria TRICARE generally applies
Office-based epidural/facet injections generally do not require Humana prior authorization; TRICARE Prime requires a referral. Facet RFA covered after at least 3 months of failed conservative care and at least 50% relief on controlled diagnostic medial-branch blocks; PULSED RFA is "unproven"/not covered (TPM Section 20.1).
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 2021-03-12.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 TRICARE require prior authorization for Pain Management Procedures?
Based on the cited policy, TRICARE does not generally require 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). Confirm with TRICARE, as this can vary by plan.
What does TRICARE require to approve Pain Management Procedures?
Office-based epidural/facet injections generally do not require Humana prior authorization; TRICARE Prime requires a referral. Facet RFA covered after at least 3 months of failed conservative care and at least 50% relief on controlled diagnostic medial-branch blocks; PULSED RFA is "unproven"/not covered (TPM Section 20.1). 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 Pain Management 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.