CPT 63688 · SCS · Wellpoint Maryland
SCS — Generator Revision/Removal at Wellpoint Maryland.
How Wellpoint Maryland approaches CPT 63688 (SCS — Generator Revision/Removal) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint Maryland policy of record for CPT 63688. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Carelon Clinical Appropriateness Guidelines — Interventional Pain Management (SCS section)
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