CPT 63650 · SCS · UnitedHealthcare Community Plan (Medicaid)
SCS — Percutaneous Trial at UnitedHealthcare Community Plan (Medicaid).
How UnitedHealthcare Community Plan (Medicaid) approaches CPT 63650 (SCS — Percutaneous Trial) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Clearway-MPG-SCSCriteria summary
High-level themes from the UnitedHealthcare Community Plan (Medicaid) 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
See the full UnitedHealthcare Community Plan (Medicaid) criteria.
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