Back & neck pain care

Applies to:

Commercial group HMO, EPO, POS and PPO plans

Commercial individual MyPriority HMO, POS and PPO plans

Medicaid and Healthy Michigan Plan

Medicare Advantage plans

Medical Policy

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.

Go to the list of Spine Centers of Excellence

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.

Spine surgery authorizations

Unless there's an acute indication for surgical evaluation (see medical policy above), all referrals to orthopedic or neurosurgeons for back pain, neck pain or other spine-related complaints require:

  • Evaluation by an SCOE (see above)
  • Participating providers: Prior authorization using the Auth Request tool, or
  • Non-participating providers: Prior authorization using our auth forms, below

Forms for requesting spine surgery