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Pain Management Procedure Codes

eviCore conducts Prior Authorization and Medical Necessity Determination (PA/MND) reviews of the procedure codes below as part of our Musculoskeletal Program for Pain Management Services. This listing was last revised on April 22, 2022 and may be subject to change.


  • 00640
  • 01939
  • 01940
  • 01941
  • 01942
  • 01991
  • 01992
  • 20552
  • 20553
  • 22505
  • 27096
  • 61790
  • 61791
  • 62263
  • 62264
  • 62290
  • 62291
  • 62292
  • 62320
  • 62321
  • 62322
  • 62323
  • 62324
  • 62325
  • 62326
  • 62327
  • 62350
  • 62351
  • 62360
  • 62361
  • 62362
  • 63650
  • 63655
  • 63663
  • 63664
  • 63685
  • 64405
  • 64451
  • 64479
  • 64480
  • 64483
  • 64484
  • 64490
  • 64491
  • 64492
  • 64493
  • 64494
  • 64495
  • 64510
  • 64520
  • 64625
  • 64633
  • 64634
  • 64635
  • 64636
  • 72285
  • 72295
  • 77003
  • 0213T
  • 0214T
  • 0215T
  • 0216T
  • 0217T
  • 0218T
  • 0627T
  • 0628T
  • 0629T
  • 0630T
  • G0259
  • G0260
  • M0076
  • S2348
  • S9090

Recent/Upcoming Changes

  • Effective June 6, 2022, as a result of the Surgical and Implantable Device Management Program expansion to include spine-related services, administered by TurningPoint, the following codes will no longer be reviewed by eviCore as part of this program: 63650, 63655, 63663, 63664, 63685, 62350, 62351, 62360, 62361 and 62362.
  • For services to be provided on and after January 1 2022, eviCore will also perform MND of the services represented by procedure codes 01939, 01940, 01941 and 01942.

Notes

  • Anesthesia services performed in conjunction with musculoskeletal pain management procedures require separate prior authorization and/or Medical Necessity Determination. Claims submitted for anesthesia services related to a pain management procedure will not be paid if there a valid authorization is not on file.
  • Procedure codes 00640, 22505, 62263, 62264, M0076, S2348 and S9090 may be considered investigational services.

CPT® is a registered trademark of the American Medical Association.