CPT 63650 · SCS · Devoted Health
SCS — Percutaneous Trial at Devoted Health.
How Devoted Health approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-26
Policy number
Clearway-MPG-SCSCriteria summary
High-level themes from the Devoted Health policy of record for CPT 63650. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Prior diagnostic procedure documentation required.
Source: Clearway Master Payer Guidelines v2025 — SCS
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