Policy Updates Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsJune 12, 2023

Carelon MSK - Spine Surgery Code updates effective November 1, 2023

Carelon Medical Benefits Management, Inc. MSK — spine surgery CPT code list update

Effective for dates of service on and after November 1, 2023, the following musculoskeletal (MSK) codes will require prior authorization through Carelon Medical Benefits Management, Inc.*

CPT® code

Description

63052

Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina, and/or nerve root(s) [for example, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment 

63053

Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina, and/or nerve root(s) [for example, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional segment 

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon Medical Benefits Management through our ProviderPortalSM:

  • Access Carelon Medical Benefits Management’s ProviderPortalSM directly at providerportal.com:
    • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

If you have questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Note: On March 1, 2023, AIM Specialty Health® began operating as Carelon Medical Benefits Management, Inc.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

WIBCBS-CD-024725-23-CPN24693

PUBLICATIONS: July 2023 Provider Newsletter