CPT 64555 · PNS · Molina Healthcare of Florida
PNS — Percutaneous Lead Trial/Placement at Molina Healthcare of Florida.
How Molina Healthcare of Florida approaches CPT 64555 (PNS — Percutaneous Lead Trial/Placement) 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
Molina MCP — Peripheral Nerve StimulationCriteria summary
High-level themes from the Molina Healthcare of Florida policy of record for CPT 64555. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic peripheral nerve block at target site with ≥50% relief documentation required (typically with ≥50% relief).
See the full Molina Healthcare of Florida criteria.
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