Prior Authorization
Humana Prior Authorization for CPT 63650
Spinal cord stimulator implantation for pain management · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Humana requires prior authorization for SCS trial (63650). FBSS, CRPS, or chronic neuropathic pain >=6 months failed conservative management. Must have tried PT, pharmacotherapy (including gabapentinoids or duloxetine), and at least one interventional procedure. Psych eval required. Trial must show >=50% pain relief over 3-7 days.
Documentation checklist
- ✓Chronic pain documentation (6+ months) with functional impact
- ✓PT records documenting treatment trial
- ✓Medication trial records with drugs, doses, and outcomes
- ✓Interventional procedure results (epidural, nerve block)
- ✓Psychological evaluation report
- ✓Trial stimulation results with pain diary (for permanent implant)
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 63650
Office (non-facility)
$2388.50
Facility
$375.43
Total RVUs (office)
71.51
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 63650 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Chronic pain documentation (6+ months) with functional impact, PT records documenting treatment trial, Medication trial records with drugs, doses, and outcomes….
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 63650?
- Yes. Humana requires prior authorization for CPT 63650 (Spinal cord stimulator implantation for pain management) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 63650?
- Chronic pain documentation (6+ months) with functional impact; PT records documenting treatment trial; Medication trial records with drugs, doses, and outcomes; Interventional procedure results (epidural, nerve block); Psychological evaluation report; Trial stimulation results with pain diary (for permanent implant)
- How much does Medicare pay for CPT 63650 in 2026?
- In 2026, the national Medicare allowable for CPT 63650 is $2388.50 in an office setting and $375.43 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 63650?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Humana PA lookups
CPT 63650 prior authorization by payer
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