Humana Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Humana generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for Commercial plans. Yes. Humana generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Humana generally applies
(1) Chronic intractable pain ≥6 months (FBSS, CRPS, refractory radiculopathy); (2) Failure of comprehensive conservative treatment including pharmacotherapy (neuropathic agents), structured PT, and ≥2 interventional procedures; (3) Psychological evaluation with clearance from licensed PhD/PsyD or MD; (4) Not a surgical candidate; (5) Successful SCS trial with ≥50% pain reduction and documented functional improvement over ≥3–7 days; (6) Multidisciplinary pain evaluation
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 Humana policy.
Commonly required documentation
- Pain history, all prior treatment records
- psychological evaluation
- SCS trial records
- imaging
- multidisciplinary pain note
How to submit
- Portal: Humana Provider Portal / Availity
- Typical turnaround: about 5 days
Source
Submit permanent implant PA after trial completion — do not submit both simultaneously. Psychological clearance mandatory. Trial records must show VAS before/after and functional metrics.
Frequently asked questions
Does Humana require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Humana generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Humana require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
(1) Chronic intractable pain ≥6 months (FBSS, CRPS, refractory radiculopathy); (2) Failure of comprehensive conservative treatment including pharmacotherapy (neuropathic agents), structured PT, and ≥2 interventional procedures; (3) Psychological evaluation with clearance from licensed PhD/PsyD or MD; (4) Not a surgical candidate; (5) Successful SCS trial with ≥50% pain reduction and documented fun… Always confirm against the current Humana policy.
How long does a Humana prior authorization take?
Humana 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 Humana?
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.