Musculoskeletal Program for Pain Management Services
PA/MND for Anesthesia Services
Anesthesia services performed in conjunction with musculoskeletal pain management procedures require separate PA/MND. Claims submitted for anesthesia services related to a pain management procedure will not be paid if there a valid authorization is not on file.
Members included in this program
- Horizon fully insured or level-funded plans/products including those members enrolled in plans that include BlueCard® benefits for care received outside of our local service area
- Horizon Medicare Advantage and Braven Health Medicare Advantage plans
- State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) employer group plans
Policies
The Horizon Medical Policies on pain management were developed using recognized evidence-based guidelines and incorporate criteria derived from published materials that are supported by nationally-recognized agencies such as the American Society of Interventional Pain Physicians, the American Pain Society, the American Academy of Pain Management and the National Institutes of Health.
Medical Policy Manual
Access our Medical Policy Manual to view clinical criteria and guidelines related to musculoskeletal pain management services.
Obtaining PA/MND
To obtain PA/MND from eviCore for musculoskeletal pain management services, please:
- Submit a request online through eviCore.com.
- Call 1-866-241-6603, between 7 a.m. and 7 p.m., Eastern Time
Code exclusions
The following codes fall under our Surgical and Implantable Device Management Program for spine-related services, and are not reviewed by eviCore as part of this program: 63650, 63655, 63663, 63664, 63685, 62350, 62351, 62360, 62361 and 62362.
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Submit PA/MND requests to TurningPoint
Please submit PA/MND requests to TurningPoint for procedure codes 62350, 62351, 62360, 62361, 62362, 63650, 63655, 63663, 63664, 63685 for patients participating in our Surgical and Implantable Device Management Program for Spine Services.
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Submit PA/MND requests to Horizon for SHBP/SEHBP patients
Please submit PA/MND requests to Horizon via our online Utilization Management Request Tool for codes 62350, 62351, 62360, 62361, 62362, 63650, 63655, 63663, 63664, 63685 for patients enrolled in State Health Benefits Program (SHBP)/School Employees' Health Benefits Program (SEHBP) plans.