Implanted Spinal Neurostimulators - JE Part B
Educational Resources
Implanted Spinal Neurostimulators
General Documentation Requirements for implanted spinal neurostimulators and related services:
- Indicate of request is trial or permanent placement;
- Physician notes include:
- Condition requiring procedure
- Physical examination
- Treatments tried and failed but not limited to:
- Spine surgery
- Physician therapy
- Medications
- Injections
- Psychological therapy
- Documentation of appropriate psychological evaluation Medicare Mental Health (MLN Booklet MLN1986542)
- For permanent placement, include documentation from above and documentation of pain relief with temporary electrode(s)
- Successful trial associated with at least 50% reduction of target pain or 50% reduction of analgesic medications
- Services associated with devices under IDE study must undergo prior authorization and meet coverage requirements in NCD 160.7
Coverage Criteria
- Local Coverage Determination: Spinal Cord Stimulators for Chronic Pain (L35136)
- Local Coverage Article (A57791)
Codes
| Code | Description |
|---|---|
| 63650 | Implantation of spinal neurostimulator electrodes accessed through the skin |
The Prior Authorization for Certain Hospital Outpatient Department Part B Associated Codes List is in Appendix B of the CMS OPD Operational Guide.
Resources
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services (CMS)
- Federal Register
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