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
Sources & verification
- BindingSource — Spinal Cord Stimulators — Medical Coverage Policy (HUM-0306-026).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.
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.