CPT 63650 · SCS · Maryland Physicians Care
SCS — Percutaneous Trial at Maryland Physicians Care.
How Maryland Physicians Care approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
NIA IPM Guidelines (2024)Criteria summary
High-level themes from the Maryland Physicians Care 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.
Source: MPC / Evolent (NIA) IPM Guidelines — Spinal Cord Stimulation
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