MedicaidPrior AuthHigh impact
Provider Letter 2024-20: RE: PA Criteria for MRI of the Lumbar Spine
Oklahoma SoonerCare·OK · Orthopedics, Neurosurgery, PM&R (Physical Medicine & Rehab) +3 more·Provider Letter
Effective date
Nov 1, 2024
We identified it
Jun 20, 2026
Summary
Oklahoma Complete Health changed prior authorization requirements for lumbar spine MRIs, increasing the required conservative therapy from 4 weeks to 6 consecutive weeks before MRI approval. This affects only Oklahoma Complete Health Medicaid members.
Action Required
Immediately: For Oklahoma Complete Health Medicaid members needing lumbar spine MRI, ensure patients complete 6 consecutive weeks of conservative therapy before submitting prior authorization requests (increased from previous 4-week requirement). Update prior auth workflows and inform providers that incomplete conservative therapy will result in MRI denials.