Aetna Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)

What Aetna generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for Commercial plans. Yes. Aetna generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

General reference compiled from public sources, last verified 2026-05-06. This is not a coverage determination or medical advice. Always confirm current requirements with Aetna before submitting.

Medical-necessity criteria Aetna generally applies

Medical necessity review required

Diagnoses that commonly support medical necessity

ICD-10-CM diagnoses frequently associated with medical necessity for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation. Confirm the covered diagnosis list against the current Aetna policy.

M96.1Postlaminectomy syndrome, not elsewhere classifiedG90.50Complex regional pain syndrome I, unspecifiedG89.4Chronic pain syndrome

Commonly required documentation

  • All requested medical records must be submitted

How to submit

  • Method: portal
  • Typical turnaround: about 3 days

Source

Includes both trial and permanent implantation procedures Last verified 2026-05-06.

Frequently asked questions

Does Aetna require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Yes. Aetna generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

What does Aetna require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Medical necessity review required Always confirm against the current Aetna policy.

How long does a Aetna prior authorization take?

Aetna typically decides Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation requests in about 3 days. Timeframes vary; check the payer portal.

Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Aetna?

Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.

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Other Aetna prior authorization requirements

ACL ReconstructionAnterior Cervical Discectomy and FusionArthroscopic Hip Surgery for Impingement Syndrome Including Labral RepairArtificial Intervertebral Disc Surgery (Cervical Spine)Artificial Intervertebral Disc Surgery (Lumbar Spine)Autologous Chondrocyte ImplantationBunionectomy (Hallux Valgus Correction)Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy ProceduresChiari Malformation Decompression SurgeryCochlear Device and/or ImplantationCT Abdomen and Pelvis with contrastCTA Chest (e.g., pulmonary embolism)

Related guides

Why was my prior authorization denied? Top reasons and how to fix eachHow to write a prior authorization appeal that cites policy