Anthem/Elevance Health Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Anthem/Elevance Health generally applies
(1) Chronic intractable pain ≥6 months; (2) Failed comprehensive conservative care: pharmacotherapy, PT, ≥2 interventional procedures; (3) Psychological evaluation clearance (licensed psychologist/psychiatrist); (4) Multidisciplinary pain evaluation; (5) Successful SCS trial ≥50% pain reduction ≥3 days; (6) Not a surgical candidate
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 Anthem/Elevance Health policy.
Commonly required documentation
- Full pain history
- all prior treatment records
- psych evaluation
- SCS trial records with VAS before/after
- imaging
- multidisciplinary note
How to submit
- Portal: Availity / Anthem Provider Portal
- Typical turnaround: about 5 days
Source
Psychological evaluation from licensed psychologist/MD required — social worker or NP evaluations not accepted by Anthem. Submit permanent implant PA after successful trial documentation.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Anthem/Elevance Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Anthem/Elevance Health require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
(1) Chronic intractable pain ≥6 months; (2) Failed comprehensive conservative care: pharmacotherapy, PT, ≥2 interventional procedures; (3) Psychological evaluation clearance (licensed psychologist/psychiatrist); (4) Multidisciplinary pain evaluation; (5) Successful SCS trial ≥50% pain reduction ≥3 days; (6) Not a surgical candidate Always confirm against the current Anthem/Elevance Health policy.
How long does a Anthem/Elevance Health prior authorization take?
Anthem/Elevance Health typically decides Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation requests in about 5 days. Timeframes vary; check the payer portal.
Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Anthem/Elevance Health?
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.