Oxford Health Plans Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)

What Oxford Health Plans generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for commercial plans. Yes. Oxford Health Plans 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 2026-06-25. This is not a coverage determination or medical advice. Always confirm current requirements with Oxford Health Plans before submitting.

Medical-necessity criteria Oxford Health Plans generally applies

Prior authorization required for spinal cord stimulator (63650/63655/63685; site of service reviewed). UnitedHealthcare Provider Portal.

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 Oxford Health Plans policy.

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

How to submit

Sources & verification

  • BindingSource — Prior Authorization Requirements for Oxford (PCA-1-22-03771) · effective 2026-01-01.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 2026-06-25.

Frequently asked questions

Does Oxford Health Plans require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Yes. Oxford Health Plans generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

What does Oxford Health Plans require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Prior authorization required for spinal cord stimulator (63650/63655/63685; site of service reviewed). UnitedHealthcare Provider Portal. Always confirm against the current Oxford Health Plans policy.

How long does a Oxford Health Plans prior authorization take?

Turnaround varies by plan and submission method. Check the Oxford Health Plans portal for current timeframes.

Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Oxford Health Plans?

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.

How Praxigen worksBook a demo

Other Oxford Health Plans prior authorization requirements

Anterior Cervical Discectomy and FusionArthroplasty (Joint Replacement)Knee ArthroscopyPain Management ProceduresShoulder Arthroscopy Rotator Cuff RepairSpinal Fusion Surgery

Related guides

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