Priority Health Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)
What Priority Health generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for commercial plans. Yes. Priority Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
Medical-necessity criteria Priority Health generally applies
Prior authorization required — two independent grounds: (a) TurningPoint program lists spinal cord neurostimulators (63650, 63655, 63661-63664, 63685, 63688); (b) Priority Health Medical Policy 91468-R28 "Stimulation Therapy and Devices" (eff. 3/1/2025) states "All stimulation devices require prior authorization by Priority Health." Detailed SCS medical-necessity criteria (trial %-relief, psych eval, FBSS/CRPS indications) live in standalone Policy 91635, which was not retrievable at sourcing — confirm there.
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 Priority Health policy.
How to submit
- Method: prism → TurningPoint (myturningpoint-healthcare.com)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Medical Policy 91468-R28 — Stimulation Therapy and Devices (91468-R28) · effective 2025-03-01.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 2026-06-26.
Frequently asked questions
Does Priority Health require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Yes. Priority Health generally requires prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).
What does Priority Health require to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?
Prior authorization required — two independent grounds: (a) TurningPoint program lists spinal cord neurostimulators (63650, 63655, 63661-63664, 63685, 63688); (b) Priority Health Medical Policy 91468-R28 "Stimulation Therapy and Devices" (eff. 3/1/2025) states "All stimulation devices require prior authorization by Priority Health." Detailed SCS medical-necessity criteria (trial %-relief, psych ev… Always confirm against the current Priority Health policy.
How long does a Priority Health prior authorization take?
Turnaround varies by plan and submission method. Check the Priority Health portal for current timeframes.
Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to Priority Health?
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.