Effective February 1, 2023, due to eviCore’s Prior Authorization of Spinal Procedures for Medicare Advantage Plan members, the following policies have been impacted and updated:

• Axial Lumbosacral Interbody Fusion
• Diagnosis and Treatment of Sacroiliac Joint Pain
• Image-Guided Minimally Invasive Spinal Decompression for Spinal Stenosis
• Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
• New Technology and Miscellaneous Services
• Prior Authorization via Web-Based Tool for Procedures