Clover Health Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Clover Health generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for medicare_advantage plans. Yes. Clover Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Clover Health generally applies
Prior authorization required for spinal cord stimulator (eviCore). Medicare NCD 160.7 governs — covered only as a late resort after other modalities fail, with multidisciplinary screening and a successful temporary trial before permanent implant.
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 Clover Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — NCD 160.7 Electrical Nerve Stimulators · effective 1995-08-07.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 2026-06-25.
Frequently asked questions
Does Clover Health require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Clover Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Clover Health require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Prior authorization required for spinal cord stimulator (eviCore). Medicare NCD 160.7 governs — covered only as a late resort after other modalities fail, with multidisciplinary screening and a successful temporary trial before permanent implant. Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Clover 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.