NCTracks
Spinal Surgeries Prior Approval Clarification
Effective August 1, 2017, providers are able to electronically submit prior approval (PA) requests through NCTracks for spinal surgery for dates of service on or after September 1, 2017. A diagnosis code is required on these PAs. Voided PA requests submitted prior to August 1 will need to be re-entered.
Note: PA must be granted prior to the service being rendered in order to be reimbursed.
DMA Clinical Coverage Policy 1A-30, Spinal Surgery, was published to the Medicaid website on August 1, 2017. Please refer to policy 1A-30 for a list of conditions that are exempt from the PA requirement.
In addition, due to recent stakeholder feedback, the psychiatric evaluation has been removed from the PA requirements for spinal surgery.
Refer to the April 2017 Medicaid Bulletin article, New Coverage and Prior Approval Requirements for Spinal Surgeries, for information regarding PA requirements and exemptions.