CPT 63650 · SCS · BCBS Alabama
SCS — Percutaneous Trial at BCBS Alabama.
How BCBS Alabama approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2024-12-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-12-01
Policy number
BCBS-AL MP-328Criteria summary
High-level themes from the BCBS Alabama policy of record for CPT 63650. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Prior Temporary trial stimulator with successful response documentation required (typically with ≥50% relief).
Source: BCBS Alabama Medical Policy MP-328 Spinal Cord and Dorsal Root Ganglion Stimulation
See the full BCBS Alabama criteria.
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