news article details

Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert

Implanted Spinal Neurostimulator Prior Authorization

National Government Services Medical Review initiated a prior authorization review outpatient department procedures for Implanted Spinal Neurostimulator on 7/1/2021.

Prior Authorization Reminder:

For Implanted Spinal Neurostimulator prior authorization, HCPCS 63650 is the only code that needs to be prior authorization for trial and permanent placement.

Documentation Requirements:

The general documentation requirements for Implanted Spinal Neurostimulator are as follows:

    • Indicate if this request is for a trial or permanent placement
    • Physician office notes including:
      • Condition requiring procedure
      • Physical evaluation
      • Treatments tried and failed including but are not limited to:
        • Spine surgery
        • Physical therapy
        • Medications
        • Injections
        • Psychological therapy
    • Documentation of psychological evaluation
    • For permanent placement, include documentation of pain relief with a temporary implanted electrode
      • A successful trial should be associated with at least 50% reduction of target pain or 50% reduction of analgesic medications.

Related Content

Posted 7/7/2021