Medicare AdvantagePrior AuthHigh impact
Prior Authorization of Spinal Procedures
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Neurosurgery, Pain Management +1 more·Physician / Facility
Effective date
Feb 1, 2023
We identified it
Jun 19, 2026
Summary
Effective February 1, 2023, Medicare Advantage Plan members now require prior authorization through eviCore for spinal procedures. This affects multiple spinal procedure categories including fusion, decompression, and stabilization devices.
Action Required
Immediately: Billing team and providers must obtain prior authorization through eviCore's web-based tool for ALL spinal procedures on Medicare Advantage patients before scheduling or performing procedures. Update scheduling workflows to verify Medicare Advantage status and obtain prior auth. Claims will be denied without proper authorization.