AIM (out-of-state / Federal BCBS) Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What AIM (out-of-state / Federal BCBS) generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for commercial plans. Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria AIM (out-of-state / Federal BCBS) generally applies
Prior authorization via Carelon. SCS TRIAL requires chronic intractable neuropathic pain from a qualifying condition (lumbosacral arachnoiditis, post-surgical nerve-root injury/FBSS, CRPS I/II by Budapest criteria, or qualifying painful diabetic neuropathy), used as a last resort after at least 6 consecutive months of physician-supervised multimodal conservative management, no untreated drug addiction, pain-specialist evaluation, at least one surgical opinion ruling out a correctable lesion (except CRPS/PDN), and a documented licensed mental-health evaluation within 6 months. PERMANENT implant requires all trial criteria PLUS a trial of at least 3 days with at least 50% reduction of target pain or analgesic use plus documented functional improvement. Carelon Interventional Pain MSK01-0626.1.
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 AIM (out-of-state / Federal BCBS) policy.
How to submit
- Method: Carelon ProviderPortal
- Portal: Carelon Medical Benefits Management
Sources & verification
- BindingSource — Carelon Clinical Appropriateness Guidelines — Interventional Pain Management (MSK01-0626.1) · effective 2026-06-14.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does AIM (out-of-state / Federal BCBS) require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does AIM (out-of-state / Federal BCBS) require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Prior authorization via Carelon. SCS TRIAL requires chronic intractable neuropathic pain from a qualifying condition (lumbosacral arachnoiditis, post-surgical nerve-root injury/FBSS, CRPS I/II by Budapest criteria, or qualifying painful diabetic neuropathy), used as a last resort after at least 6 consecutive months of physician-supervised multimodal conservative management, no untreated drug addic… Always confirm against the current AIM (out-of-state / Federal BCBS) policy.
How long does a AIM (out-of-state / Federal BCBS) prior authorization take?
Turnaround varies by plan and submission method. Check the AIM (out-of-state / Federal BCBS) portal for current timeframes.
Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to AIM (out-of-state / Federal BCBS)?
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.