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

What UMR generally requires to approve Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661), for commercial plans. Prior authorization requirements vary by plan. Confirm with UMR for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

General reference compiled from public sources, last verified 2026-06-26. This is not a coverage determination or medical advice. Always confirm current requirements with UMR before submitting.

Medical-necessity criteria UMR generally applies

Clinical criteria governed by UMR Medical Policy "Implanted Electrical Stimulator for the Spinal Cord." Spinal cord/dorsal-column stimulator review IS required for some employer groups (observed on a sampled group list); PA applicability is plan-specific — verify with the per-member PA tool on umr.com.

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 UMR policy.

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

How to submit

  • Method: UMR provider portal (per-member PA tool)
  • Portal: UMR

Sources & verification

  • BindingSource — UMR Medical Policy — Implanted Electrical Stimulator for the Spinal Cord (UHC-published) · effective 2025-11-01.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 UMR require prior authorization for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation?

Prior authorization requirements vary by plan. Confirm with UMR for Dorsal Column (Lumbar) Neurostimulators: Trial or Implantation (CPT 63650, 63655, 63663, 63664, 63685, 63688, 63661).

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

Clinical criteria governed by UMR Medical Policy "Implanted Electrical Stimulator for the Spinal Cord." Spinal cord/dorsal-column stimulator review IS required for some employer groups (observed on a sampled group list); PA applicability is plan-specific — verify with the per-member PA tool on umr.com. Always confirm against the current UMR policy.

How long does a UMR prior authorization take?

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

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

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 UMR prior authorization requirements

Anterior Cervical Discectomy and FusionArthroplasty (Joint Replacement)Arthroscopic Hip Surgery for Impingement Syndrome Including Labral RepairArtificial Intervertebral Disc Surgery (Cervical Spine)Artificial Intervertebral Disc Surgery (Lumbar Spine)Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy ProceduresKnee ArthroscopyKnee MeniscectomyPain Management ProceduresShoulder Arthroscopy Rotator Cuff RepairSpinal Fusion SurgeryVertebroplasty/Kyphoplasty

Related guides

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