CPT 62350 · Intrathecal Pump · Health Partners Plans / Jefferson Health Plans — PA HealthChoices
Pain Pump — Catheter Implantation (tunneled) at Health Partners Plans / Jefferson Health Plans — PA HealthChoices.
How Health Partners Plans / Jefferson Health Plans — PA HealthChoices approaches CPT 62350 (Pain Pump — Catheter Implantation (tunneled)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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eviCore IT Drug DeliveryCriteria summary
High-level themes from the Health Partners Plans / Jefferson Health Plans — PA HealthChoices policy of record for CPT 62350. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Prior Successful intrathecal trial (single-shot or continuous) demonstrating ≥50% pain relief and improved function documentation required (typically with ≥50% relief).
See the full Health Partners Plans / Jefferson Health Plans — PA HealthChoices criteria.
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