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Spine Management and Prior Authorization

Starting on July 1, 2014, Harvard Pilgrim will require prior authorization on selected spinal surgeries and injections. Prior authorization will be required for the following:

  • Non-emergent inpatient and outpatient spine surgeries: lumbar microdiscectomy; lumbar decompression (laminotomy, laminectomy, facetectomy, and foraminotomy); and lumbar spine fusion (arthrodesis)
  • Non-emergent outpatient interventional spine pain (IPM) management services: spinal epidural injections; paravertebral facet joint injections or blocks; paravertebral facet joint denervation [Radiofrequency (RF) Neurolysis]

Harvard Pilgrim has chosen National Imaging Associates, Inc. (NIA) to provide utilization management for the services listed above; all prior authorization requests for these services should be made through NIA.

The following materials provide in-depth information about spine management and prior authorization:

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Quick Reference Guide*

FAQ for IPM Procedures*

FAQ for Inpatient and Outpatient Spine Surgeries*

Provider Checklist for IPM procedures*

Provider Checklist for Inpatient and Outpatient Spine Surgeries*