CPT 63650 · SCS
SCS — Percutaneous Trial
Percutaneous implantation of neurostimulator electrode array, epidural (spinal cord stimulator trial).
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Rubrica tracks payor coverage for CPT 63650 (SCS — Percutaneous Trial) across 114 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 63650
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Better Health Medicaid | Covered | Prior auth |
| Aetna Better Health of Florida | Covered | Prior auth |
| Aetna Better Health of Maryland | Covered | Prior auth |
| Aetna Better Health of New Jersey | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| Ambetter | Covered | Prior auth |
| AmeriHealth Caritas | Covered | Prior auth |
Coverage themes for CPT 63650
Common patterns across the 114 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥26 weeks of conservative care before approving 63650.
15 of 114 payors require imaging concordance documentation.
Of the 114 payors with coverage records for CPT 63650, 81 require prior authorization, 33 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
See the policy for every payor.
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