TRICARE Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation prior authorization requirements (2026)

What TRICARE generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for tricare plans. Yes. TRICARE 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 TRICARE before submitting.

Medical-necessity criteria TRICARE generally applies

Spinal cord stimulator covered for chronic intractable pain (TPM Section 20.1) as implanted surgery; verify authorization/notification with Humana Military.

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 TRICARE policy.

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

How to submit

Sources & verification

  • BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 20.1 (Nervous System) · effective 2021-03-12.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 TRICARE require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

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

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

Spinal cord stimulator covered for chronic intractable pain (TPM Section 20.1) as implanted surgery; verify authorization/notification with Humana Military. Always confirm against the current TRICARE policy.

How long does a TRICARE prior authorization take?

Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.

Submitting Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation to TRICARE?

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 TRICARE 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