CMM-600: Preface to the Spine Surgery

EviCore requires prior authorization for elective (and reviews urgent/emergent) spine surgery under its Clinical Review Criteria and does not endorse or use discography or MR spectroscopy to determine medical necessity. Key requirements include submission ≥2 weeks before elective surgery with CPT/ICD-10 codes and levels, independent radiologist reports for CT/MRI/myelography, detailed provider‑directed non‑surgical treatment history and responses, required ESI/SNRB trials unless contraindicated, flexion‑extension/plain X‑rays for fusion when indicated, and nicotine‑free evidence for fusion (never‑smoker or ≥6 weeks cessation with blood cotinine ≤10 ng/mL), while confirmed urgent/emergent cases waive many of these requirements per NCQA standards.

"Prior-authorization requests for elective spinal surgery (requests should be submitted at least two weeks prior to the anticipated date of an elective spinal surgery)."