Medicare (CMS LCD/NCD) Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)

What Medicare (CMS LCD/NCD) generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for Medicare plans. Yes. Medicare (CMS LCD/NCD) generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

General reference compiled from public sources, last verified 2026-06-10. This is not a coverage determination or medical advice. Always confirm current requirements with Medicare (CMS LCD/NCD) before submitting.

Medical-necessity criteria Medicare (CMS LCD/NCD) generally applies

Covered for chronic intractable pain as a late resort after other modalities (pharmacologic, surgical, physical, and psychological therapies) have been tried and failed or are judged unsuitable/contraindicated, with at least one documented failed conservative treatment. A successful trial stimulation (at least 50% reduction in target pain or analgesic use, with some functional improvement) is a prerequisite before permanent implantation; psychological evaluation is typically required.

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 Medicare (CMS LCD/NCD) policy.

M96.1Postlaminectomy syndrome, not elsewhere classifiedG90.50Complex regional pain syndrome I, unspecifiedG89.4Chronic pain syndrome

Source

Source: CMS NCD 160.7 (Electrical Nerve Stimulators) and LCD Spinal Cord Stimulators for Chronic Pain (L37632). Last verified 2026-06-10.

Frequently asked questions

Does Medicare (CMS LCD/NCD) require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Yes. Medicare (CMS LCD/NCD) generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

What does Medicare (CMS LCD/NCD) require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Covered for chronic intractable pain as a late resort after other modalities (pharmacologic, surgical, physical, and psychological therapies) have been tried and failed or are judged unsuitable/contraindicated, with at least one documented failed conservative treatment. A successful trial stimulation (at least 50% reduction in target pain or analgesic use, with some functional improvement) is a pr… Always confirm against the current Medicare (CMS LCD/NCD) policy.

How long does a Medicare (CMS LCD/NCD) prior authorization take?

Turnaround varies by plan and submission method. Check the Medicare (CMS LCD/NCD) portal for current timeframes.

Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Medicare (CMS LCD/NCD)?

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.

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Other Medicare (CMS LCD/NCD) prior authorization requirements

Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy ProceduresCT Abdomen and Pelvis with contrastDiabetic Therapeutic Shoes & InsertsLumbar Spinal FusionMRI Brain without contrastMRI Lower Extremity Joint without contrastMRI Lumbar Spine without contrastOutpatient Physical TherapyTotal Knee Arthroplasty

Related guides

Why was my prior authorization denied? Top reasons and how to fix eachHow to write a prior authorization appeal that cites policy