Does Humana require prior authorization for CPT 63047?

Yes. Humana requires prior authorization for CPT 63047 (Spinal surgery procedures) under Standard commercial plans per its published clinical policy.

What documentation does Humana require for CPT 63047?

Lumbar spine MRI/CT; Conservative treatment records; Neurological exam; Physical therapy documentation

How much does Medicare pay for CPT 63047 in 2026?

In 2026, the national Medicare allowable for CPT 63047 is $1065.49 in an office setting and $1065.49 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.

What if Humana denies the PA for CPT 63047?

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

Humana Prior Authorization for CPT 63047

Spinal surgery procedures · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified January 1, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Humana Commercial Preauthorization and Notification List (July 2024)

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

Humana requires prior authorization for lumbar laminectomy. Approved for symptomatic spinal stenosis with neurogenic claudication or radiculopathy after 6+ weeks of conservative management, and progressive neurological deficit. Imaging must correlate with clinical findings. Emergency decompression for cauda equina is covered without prior authorization.

Documentation checklist

✓Lumbar spine MRI/CT
✓Conservative treatment records
✓Neurological exam
✓Physical therapy documentation

Submission channels

Phone

1-800-444-9137

Fax

1-877-418-0506

2026 Medicare rate for CPT 63047

Office (non-facility)

$1065.49

Facility

$1065.49

Total RVUs (office)

31.90

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 63047 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Lumbar spine MRI/CT, Conservative treatment records, Neurological exam….
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 Humana require prior authorization for CPT 63047?: Yes. Humana requires prior authorization for CPT 63047 (Spinal surgery procedures) under Standard commercial plans per its published clinical policy.
What documentation does Humana require for CPT 63047?: Lumbar spine MRI/CT; Conservative treatment records; Neurological exam; Physical therapy documentation
How much does Medicare pay for CPT 63047 in 2026?: In 2026, the national Medicare allowable for CPT 63047 is $1065.49 in an office setting and $1065.49 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
What if Humana denies the PA for CPT 63047?: 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.

Other Humana PA lookups

CPT 17110 CPT 45380 CPT 45378 CPT 11042 CPT 36415 CPT 20610 CPT 62323 CPT 43235

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