CPT 63650 · SCS · Horizon BCBS NJ
SCS — Percutaneous Trial at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2026-05-11, the policy covers this code with prior authorization required.
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067Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ 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: Horizon BCBSNJ Medical Policy 067 — Spinal Cord and Implantable Peripheral Nerve Stimulators
See the full Horizon BCBS NJ criteria.
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