Optum Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Optum generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for Commercial plans. Yes. Optum generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Optum generally applies
(1) Chronic intractable pain ≥6 months; (2) Failed comprehensive conservative care; (3) Psychological clearance (licensed PhD/PsyD or MD); (4) Successful SCS trial ≥50% reduction ≥3 days; (5) Multidisciplinary pain evaluation; (6) Not a surgical candidate
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 Optum policy.
Commonly required documentation
- Pain history
- all prior treatment records
- psych evaluation
- SCS trial records
- imaging
- multidisciplinary note
How to submit
- Portal: Optum ProviderConnect / Availity
- Typical turnaround: about 5 days
Source
Submit trial and permanent implant as separate PA requests. Psychological evaluation mandatory. Upload all documents at submission for fastest review.
Frequently asked questions
Does Optum require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Optum generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Optum require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
(1) Chronic intractable pain ≥6 months; (2) Failed comprehensive conservative care; (3) Psychological clearance (licensed PhD/PsyD or MD); (4) Successful SCS trial ≥50% reduction ≥3 days; (5) Multidisciplinary pain evaluation; (6) Not a surgical candidate Always confirm against the current Optum policy.
How long does a Optum prior authorization take?
Optum 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 Optum?
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.