Musculoskeletal Surgery and Interventional Pain Management Services Prior Authorization Program

Effective Aug. 1, 2024, Highmark New York is requiring prior authorization for inpatient and outpatient musculoskeletal (MSK) procedures. New and continuing authorization requirements for inpatient and outpatient MSK services will be managed directly by Highmark New York.

These changes apply to Highmark New York members enrolled in our fully insured Commercial, Medicare Advantage, Affordable Care Act (ACA) plans, and members of select self-insured (Administrative Services Only) groups.

Highmark’s List of Procedures/DME Requiring Authorization will be updated with CPT codes for MSK procedures, including the following services:

  • Large joint surgeries
  • Spine surgeries
  • Interventional pain management procedures


Requesting Authorization for MSK Services

Authorization requests should be submitted through Availity®, Highmark’s online provider portal. Once you log in to Availity, you will access the Predictal™ Auto Automation Hub to request authorization for MSK procedures.


Authorization Requirements

For additional information and resources on submitting authorizations, CLICK HERE.

Last updated on 4/29/2024 9:51:12 AM


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