UMR Pain Management Procedures prior authorization requirements (2026)
What UMR 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. Prior authorization requirements vary by plan. Confirm with UMR 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 UMR generally applies
Clinical criteria governed by UMR Medical Policies for facet/epidural/sacroiliac interventions (e.g., "Sacroiliac Joint Interventions"). PA applicability is plan-specific and varies markedly by group — a sampled employer group explicitly EXEMPTED epidural injections from preauthorization. Verify with the per-member PA tool on umr.com.
How to submit
- Method: UMR provider portal (per-member PA tool)
- Portal: UMR
Sources & verification
- BindingSource — UMR Medical Policy library — Sacroiliac Joint / facet / epidural interventions (plan-specific PA).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 Pain Management Procedures?
Prior authorization requirements vary by plan. Confirm with UMR 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 UMR require to approve Pain Management Procedures?
Clinical criteria governed by UMR Medical Policies for facet/epidural/sacroiliac interventions (e.g., "Sacroiliac Joint Interventions"). PA applicability is plan-specific and varies markedly by group — a sampled employer group explicitly EXEMPTED epidural injections from preauthorization. Verify with the per-member PA tool on umr.com. 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 Pain Management 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.