UMR Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What UMR 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 commercial plans. Prior authorization requirements vary by plan. Confirm with UMR 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).
Medical-necessity criteria UMR generally applies
PLAN-SPECIFIC — UHC commercial generally requires PA/notification for spine surgery, but applicability is plan-dependent; verify per-member via umr.com PA tool. [NEEDS CLINICAL SPOT-CHECK]
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 UMR policy.
How to submit
- Method: UMR provider portal (per-member PA tool)
- Portal: UMR
Sources & verification
- BindingSource — UMR Medical & Drug Policies (UHC-published) + UMR per-member Prior Authorization tool · effective 2025-11-01.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 UMR require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Prior authorization requirements vary by plan. Confirm with UMR 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).
What does UMR require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
PLAN-SPECIFIC — UHC commercial generally requires PA/notification for spine surgery, but applicability is plan-dependent; verify per-member via umr.com PA tool. [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current UMR policy.
How long does a UMR prior authorization take?
Turnaround varies by plan and submission method. Check the UMR portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to UMR?
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.