62287 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 62287

29 of 29 payer prior-auth lists that name 62287 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Cigna, HealthSpring, Humana, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)AZ Blue-administered Medicare Advantage (M2K)AZprior auth requiredSep 1, 2026AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaMusculoskeletalAllprior auth requiredMar 7, 2026Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
CignaMusculoskeletalAllprior auth requiredMar 7, 2026Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Spine Surgery
Blue Cross and Blue Shield of IllinoisBlue Cross Community Health Plans (BCCHP), Illinois MedicaidILprior auth requiredJan 1, 2020Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of IllinoisBlue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)ILprior auth requiredeviCore-managedJan 1, 2020Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana Healthy HorizonsILprior auth requiredJan 1, 2027Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
HumanaHumana Healthy HorizonsINprior auth requiredJan 1, 20271 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
HumanaHumana Healthy HorizonsOHprior auth requiredJan 1, 2027555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
HumanaHumana Healthy HorizonsSCprior auth requiredJan 1, 2027Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Connected (Texas MMP)TXprior auth requiredJan 1, 2015Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U

Payer coverage policies that name 62287

62287 appears in 35 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaBack Pain - Invasive Procedures (0016)listed, no stanceOct 6, 2026payer document
AetnaBack Pain - Invasive Procedures (0016)not coveredOct 6, 2026payer document
AetnaIntradiscal Procedures (0602)not coveredSep 2, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 62263-63746)Jun 19, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 61000-64999)Jul 1, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 62263-63746)Jul 23, 2026payer document
AetnaRespiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479)listed, no stance (range 61000-64999)Jul 9, 2026payer document
AetnaThermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703)listed, no stance (range 61000-64999)Nov 24, 2025payer document
AetnaYAG Laser in Ophthalmology and Other Selected Indications (0354)listed, no stanceMay 21, 2026payer document
AnthemPercutaneous Spinal Surgery (SURG.00071)unproven / investigationalMay 14, 2026payer document
Blue Cross & Blue Shield of MississippiAutomated Percutaneous And Percutaneous Endoscopic Discectomyunproven / investigationalpayer document
Blue Cross & Blue Shield of MississippiDecompression Of The Intervertebral Disc Using Laser Energy Laser Discectomy Or Radiofrequency Coblation Nucleoplastyunproven / investigationalpayer document
Blue Cross & Blue Shield of Rhode IslandMinimally Invasive Procedures for Back Painnot coveredAug 19, 2026payer document
Blue Cross Blue Shield of MassachusettsAutomated Percutaneous and Percutaneous Endoscopic Discectomy (231)unproven / investigationalpayer document
Blue Cross Blue Shield of MassachusettsDecompression of the Intervertebral Disc Using Laser Energy (271)unproven / investigationalpayer document
Blue Cross NCAutomated Percutaneous and Endoscopic Discectomylisted, no stanceMay 1, 2026payer document
Blue Cross NCDecompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)listed, no stanceOct 1, 2025payer document
BlueCross BlueShield of South CarolinaDecompression of the Intervertebral Disc Using Laser (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty™) (CAM 70193)listed, no stanceJun 1, 2026payer document
CenteneDisc Decompression Procedures (CP.MP.114)covered if criteria are metApr 1, 2026payer document
CignaIntraoperative Monitoring (0509)not coveredSep 15, 2025payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Automated Percutaneous Discectomy and Percutaneous Endoscopic Discectomy (SUR712.004)listed, no stanceOct 15, 2025payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty) (SUR712.037)listed, no stanceNov 15, 2025payer document
Premera Blue CrossAutomated Percutaneous and Percutaneous Endoscopic Discectomy (7.01.18)listed, no stanceAug 10, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (CS364.D)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (2026T0640H)listed, no stanceFeb 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Idaho Only) (CS364ID.B)listed, no stanceMay 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Kansas Only) (CS364KS.02)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Kentucky Only) (CS364KY.04)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Nebraska Only) (CS364NE.D)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for New Jersey Only) (CS364NJ.D)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for New Mexico Only) (CS364NM.C)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for North Carolina Only) (CSNCT0364.04)listed, no stanceApr 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Ohio Only) (CS364OH.D)listed, no stanceApr 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Pennsylvania Only) (CS364PA.D)listed, no stanceMar 1, 2026payer document
UnitedHealthcareMinimally Invasive Spine Surgery Procedures (for Tennessee Only) (CS364TN.D)listed, no stanceMar 1, 2026payer document
UnitedHealthcareSpine Procedures (MMP089.18)
Percutaneous Lumbar Decompression of Nucleus Pulposus
listed, no stanceAug 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Jul 1, 2026: PA added, Humana
  • Jul 1, 2026: PA added, Humana

Medicaid fee-for-service

Prior authorization required or conditional in WA.

  • AZ: $556.61 (asc), effective Oct 1, 2026
  • CO: $444.46 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $416.84 (physician, non-facility), effective Jan 1, 2026
  • IL: $481.80 (practitioner), effective Jul 1, 2026
  • IN: $467.92 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $100.00 (asc, facility), effective Aug 1, 1982
  • KY: $926.03 (asc), effective Jan 1, 2026
  • LA: $265.13 (asc), effective Jul 1, 2012
  • MA: $677.27 (asc), effective May 1, 2026
  • MS: $739.94 (comprehensive, facility), effective Oct 1, 2025
  • ND: $545.90 (physician, facility), effective Aug 1, 2026
  • NE: $1000.00 (asc), effective Jul 1, 2024
  • NY: $265.61 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $426.65 (physician), effective Jan 1, 2024
  • OK: $844.84 (asc), effective Jan 1, 2026
  • TX: $659.94 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $462.38 (medical), effective Jul 1, 2026
  • VT: $1516.22 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $863.57 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.