CPT 63650 · SCS · Florida Blue
SCS — Percutaneous Trial at Florida Blue.
How Florida Blue approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2026-02-26, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-02-26
Policy number
02-61000-05Criteria summary
High-level themes from the Florida Blue policy of record for CPT 63650. Verbatim policy text and per-criterion analysis are available after sign-in.
- Conservative care expectations vary; sign in for specifics.
- Prior Trial of temporarily implanted electrode (63650 trial) with ≥50% pain relief documentation required (typically with ≥50% relief).
Source: Florida Blue MCG 02-61000-05 Spinal Cord and Dorsal Root Ganglion Stimulation
See the full Florida Blue criteria.
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