If you submit injection authorization requests, you have come to the right place! This article reviews how to submit injection authorizations and the required documentation for both Commercial and Medicare requests for the following services:
Sacroiliac joint injections (SI joint)
Spine facet joint injections
Initial & repeat spine radiofrequency ablation(RFA)
Epidural steroid injections (ESI)
Medial branch block (MBB)
How to Submit
Update the units
The number of units is the number of injections for this requested procedure.
Certain fields may auto-populate with a suggested place of service or the number of units. You have the ability to make edits as needed.
Dates of service
Indicate the date range in which the planned injections will take place.
Attach all of the appropriate clinical documentation
All of the documentation that you include should meet authorization requirements. For every authorization, regardless of service, clinical documentation MUST include two (2) patient identifiers:
Either full name and date of birth; OR
Full name and health plan member ID (we cannot accept the patient's medical record number as an identifier because we do not have that information available when completing reviews)
This information should be included either on all pages of the document or on the first page of the document with other pages in continuation of the first page (ex. 1/10, 2/10, 3/10, etc)
Answer the clinical assessment questions
As appropriate, use the clinical assessment questions to indicate the level of injection and whether or not the procedure is being performed bilaterally.