CPT 62365 · Intrathecal Pump · Highmark Wholecare — PA HealthChoices
Pain Pump — Removal at Highmark Wholecare — PA HealthChoices.
How Highmark Wholecare — PA HealthChoices approaches CPT 62365 (Pain Pump — Removal) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
HealthHelp IPM — Intrathecal Drug Delivery System (Pain Pump)Criteria summary
High-level themes from the Highmark Wholecare — PA HealthChoices policy of record for CPT 62365. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Prior Intrathecal trial (single-shot or external infusion) documentation required (typically with ≥50% relief).
See the full Highmark Wholecare — PA HealthChoices criteria.
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