Review the Musculoskeletal Program for Spine Surgery Services Clinical Guidelines
The clinical guidelines used by eviCore healthcare (eviCore) to make Prior Authorization and Medical Necessity Determination (PA/MND) decisions for Spine Surgery services have moved to eviCore’s website.
To access the Spine Surgery guidelines, (which pertain only to members who are enrolled in Horizon BCBSNJ plans that participate in the Musculoskeletal Program administered by eviCore1), please visit www.evicore.com/HorizonSpineSurgery.
A link to these guidelines, as well as the list of the Spine Surgery procedure codes that are included in our Musculoskeletal Program (and for which PA/MND should be obtained), may also be found at HorizonBlue.com/musculoskeletal under the Spine Surgery tab.
If you have questions about the Musculoskeletal Program for Spine Surgery Services or these guidelines, please call 1-866-241-6603.
1 Horizon BCBSNJ maintains and displays similar medical policies within our Medical Policy Manual the guidelines of which pertain only to members enrolled in plans that do not participate in the Musculoskeletal Program administered by eviCore.
Obtain PA/MND for Spine Surgery Services
To obtain PA/MND from eviCore for a Spine Surgery service, please:
- Submit a request online through www.evicore.com; or
- Call eviCore at 1-866-241-6603, between 7 a.m. and 7 p.m., Eastern Time.
If you are seeking PA for procedure codes that are not managed by eviCore, please call Horizon BCBSNJ’s Physician Services at 1-800-624-1110.