Horizon BCBS NJ Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Horizon BCBS NJ generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for PPO plans. Yes. Horizon BCBS NJ generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Horizon BCBS NJ generally applies
Prior authorization required; managed by TurningPoint Healthcare Solutions under the Horizon Surgical & Implantable Device Management Program (SCS implant codes 63650/63655/63663/63664/63685 moved off eviCore to TurningPoint eff 6/6/2022). The binding TurningPoint OR criteria are portal-only [SPOT-CHECK]; the public clinical standard is Horizon's own Policy 067 (Spinal Cord and Implantable Peripheral Nerve Stimulators). A short-term percutaneous trial (e.g., >48 hours) precedes permanent implantation. Medical necessity is indication-specific. For Failed Back Surgery Syndrome and CRPS/RSD: at least 6 consecutive months of supervised conservative management have failed; surgery is not indicated or is declined; a mental-health evaluation shows no inadequately controlled conditions; and for the permanent implant, the trial produced at least a 50% reduction in pain. For chronic critical limb ischemia and chronic stable angina (CCS III/IV, not a revascularization candidate, optimal medical therapy failed): mental-health clearance and a beneficial clinical response from the temporary trial electrode before permanent implant. Thresholds quoted from Horizon Policy 067; confirm exact numerics against the live policy.
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 Horizon BCBS NJ policy.
Related procedure codes
Codes often billed alongside Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation: 63650, 63655, 63661, 63663, 63664, 63685, 63688. Verify the correct codes for your documentation.
Commonly required documentation
- Diagnosis/indication
- at least 6 months of documented supervised conservative management and outcomes
- documentation that surgery is not indicated or is declined
- psychological/mental-health evaluation
- for the permanent implant, trial results documenting at least 50% pain relief (or beneficial response for ischemia/angina)
- device type (high-frequency vs conventional). Exact TurningPoint documentation checklist is portal-only [SPOT-CHECK].
Situations to verify before submitting
Horizon BCBS NJ may not cover Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation in these situations. Verify against the current policy rather than assuming a denial:
- High-frequency SCS is investigational for any indication other than the approved ones (incl. CRPS/RSD)
- Non-high-frequency dorsal column SCS is investigational for post-amputation/phantom limb pain, post-herpetic neuralgia, peripheral neuropathy, and dysesthesias from spinal cord injury
- Dorsal root ganglion (DRG) stimulation is investigational for ALL indications
- Peripheral nerve stimulation / peripheral nerve field stimulation is investigational for acute or chronic pain
- Replacing a functioning conventional SCS with a high-frequency SCS is not medically necessary
How to submit
- Method: portal
- Portal: TurningPoint Healthcare Solutions Web Portal
Sources & verification
- BindingPayer medical policy — Horizon Policy 067 - Spinal Cord and Implantable Peripheral Nerve Stimulators (067) · effective 2020-02-14.View
- Portal-onlyTurningPoint — Horizon Surgical & Implantable Device Management Program (TurningPoint) - SCS routing.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 2026-06-19.
Frequently asked questions
Does Horizon BCBS NJ require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Horizon BCBS NJ generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Horizon BCBS NJ require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Prior authorization required; managed by TurningPoint Healthcare Solutions under the Horizon Surgical & Implantable Device Management Program (SCS implant codes 63650/63655/63663/63664/63685 moved off eviCore to TurningPoint eff 6/6/2022). The binding TurningPoint OR criteria are portal-only [SPOT-CHECK]; the public clinical standard is Horizon's own Policy 067 (Spinal Cord and Implantable Periphe… Always confirm against the current Horizon BCBS NJ policy.
How long does a Horizon BCBS NJ prior authorization take?
Turnaround varies by plan and submission method. Check the Horizon BCBS NJ portal for current timeframes.
Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Horizon BCBS NJ?
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.