Billing and Coding: Spinal Cord Stimulators for Chronic Pain

Medicare covers temporary SCS trials (CPT 63650) performed in office, ASC, outpatient hospital, or hospital and one permanent SCS implant (CPT 63655) per patient lifetime when supported by clinical documentation of diagnosis and prior therapies. Temporary trials are generally limited to two per anatomic spinal region per date of service or four units lifetime (with limited exceptions), repeat trials require documented extenuating circumstances, CPT 63663 is not reimbursed in office settings, and providers must comply with CCI edits and be prepared to submit selection criteria, imaging, and medical necessity documentation upon review.

"Spinal cord stimulation (SCS) is covered for chronic pain when the clinical record documents the diagnosis and prior conservative therapies tried before the decision to use SCS."

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