63688
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.24
Facility
$305.62
Non-Facility
$305.62
Documentation Required
- Appropriate medical documentation supporting need for repeat trial or exceptions (e.g., technical limitations, different modality/new technology) must be submitted for appeals.
- Providers must verify applicable CCI edits and correct coding guidelines prior to billing Medicare; this article does not replace CCI guidance.
- Medical record must contain documented history and careful screening, including multidisciplinary evaluation and both psychological and physical assessments, available on request.
- All trials that proceed to permanent implants must have adequate chart documentation demonstrating trial effectiveness and the medical rationale for permanent implantation.
Key Coverage Criteria
- Placement of up to 2 spinal cord stimulator leads or a maximum of 16 contacts is reimbursable.
- Up to 2 SCS trials per anatomic spinal region per patient per lifetime are reimbursable, with exceptions for technical limitations or use of different stimulation modalities/new technology.
- CPT 63650 (temporary/percutaneous SCS trial) is reimbursable in office, ASC, outpatient hospital, or hospital settings.
- Permanent spinal cord stimulator implantation (CPT 63655) is reimbursable once per patient per lifetime and must be performed in an ASC, outpatient hospital, or hospital.
- Percutaneous placement of permanent neurostimulator arrays (using CPT 63650) may be covered more often when performed in ASC, outpatient hospital, or hospital settings.
- Spinal cord stimulation (SCS) is covered for chronic intractable neuropathic pain when other conservative treatments have failed.
12 Active Policies
AETNA-CPB-0194 — Spinal Cord Stimulation
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
AETNA-CPB-0729 — Diabetic Neuropathy: Selected Treatments
A56876 — Billing and Coding: Spinal Cord Stimulators for Chronic Pain
L37632 — Spinal Cord Stimulators for Chronic Pain
Related Codes
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