What documentation does Aetna require for CPT 62323?

Completed EviCore preauthorization request; Medical records requested for delegated clinical review

How much does Medicare pay for CPT 62323 in 2026?

In 2026, the national Medicare allowable for CPT 62323 is $273.22 in an office setting and $89.18 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.

What if Aetna denies the PA for CPT 62323?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Aetna Prior Authorization for CPT 62323

Interlaminar epidural or subarachnoid injection, lumbar or sacral, with imaging guidance · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified May 9, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Aetna lists this code under Special programs: Pain management. The PDF states precertification is required for all members with plans applicable to this precertification list unless services are emergent, with EviCore used where applicable. Evidence: PDF p.36, Special programs, Pain management.

Documentation checklist

✓Completed EviCore preauthorization request
✓Medical records requested for delegated clinical review

Submission channels

Phone

1-888-622-7329

Fax

1-855-774-1319

2026 Medicare rate for CPT 62323

Office (non-facility)

$273.22

Facility

$89.18

Total RVUs (office)

8.18

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 62323 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Completed EviCore preauthorization request, Medical records requested for delegated clinical review.
3Submit via phone or fax, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 62323?: Yes. Aetna requires prior authorization for CPT 62323 (Interlaminar epidural or subarachnoid injection, lumbar or sacral, with imaging guidance) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT 62323?: Completed EviCore preauthorization request; Medical records requested for delegated clinical review
How much does Medicare pay for CPT 62323 in 2026?: In 2026, the national Medicare allowable for CPT 62323 is $273.22 in an office setting and $89.18 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
What if Aetna denies the PA for CPT 62323?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

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CPT 62323 prior authorization by payer

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