Prior Authorization for Spinal Cord Stimulation Procedures
Apr 13, 2021
Beginning July 1, 2021, selected spinal cord stimulation (SCS) procedures will require prior authorization when performed in an outpatient hospital department.
The rule, which the Centers for Medicare and Medicaid Services adopted this past March, will apply to the following codes:
- 63650 – percutaneous implantation of neurostimulator electrode array, epidural (trial and/or implant)
- 63685 – insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
- 63688 – revision or removal of implanted spinal neurostimulator pulse generator or receiver
SCS procedures performed in an ambulatory surgery center, critical access hospital, or physician office setting are not impacted by the rule. It also does not impact Medicare Advantage patients.
A full list of procedures that require prior authorization can be found here.