Back & neck pain care
Commercial group HMO, EPO, POS and PPO plans
Commercial individual MyPriority HMO, POS and PPO plans
Medicaid and Healthy Michigan Plan
Medicare Advantage plans
- Spine Centers of Excellence - 91531
Back and neck pain clinical practice guideline
Spine Centers of Excellence (SCOE) evaluations
This evaluation is required before surgical evaluation for Priority Health patients.
Physiatrist-led multi-disciplinary SCOE clinics offer patients the best and most appropriate care. Physiatrists are physicians who are trained to diagnose and manage musculoskeletal problems, including spine- or back-related problems.
SCOEs help ensure that all patients with persistent neck and back pain or other spine-related problems receive a timely, comprehensive, non-surgical medical evaluation.
Through an SCOE, patients receive:
- An evaluation
- In-person acute case reviews
- Treatment that usually does not require surgery
Making a referral to a SCOE
Any participating primary care physician, emergency room physician or urgent care center can refer members to a Priority Health Spine Center of Excellence at any point in the treatment process without prior authorization, including before or after failure of conservative care.
Follow-up after an evaluation
The SCOE physiatrist confirms a diagnosis, and gives patients and the referring physician treatment recommendations. Shared decision-making tools help patients understand the various treatment options, including their risks and benefits.
Become a Spine Center of Excellence practice
Spine Center of Excellence practices helps ensure that all patients with persistent neck and back pain or other spine-related conditions receive a timely, comprehensive, non-surgical medical evaluation before surgery and for an initial surgery referral. To participate in the program review the requirements, complete the application form below and submit them to PH-PELC@priorityhtelath.com.
- Spine Center of Excellence requirements
- Spine Center of Excellence affidavit
- Spine Center of Excellence application form
If you have any questions, contact the Provider Helpline at 800.942.4765.
Spine surgery authorizations
In most cases, unless regular post-operative surgeon visits are necessary, all referrals to orthopedic or neurosurgeons for back pain, neck pain or other new spine-related complaints require:
- Evaluation by a SCOE (see above). This is applicable prior to surgery and for an initial surgery referral.
- Prior authorization from provider. Participating providers can use the Authorization Request tool. Non-participating providers should use the authorization forms below.
Forms for requesting spine surgery
- Spine referral for neurosurgeon or orthopedic surgeon evaluation prior authorization form
- Sacroiliac (SI) joint fusion prior authorization form
Surgical visits outside the global billing period will follow standard billing and coding practices (see medical policy above for authorization requirements).