Rubrica

CPT 95990 · Intrathecal Pump · Molina Healthcare of Florida

Pain Pump — Refill (by clinician) at Molina Healthcare of Florida.

How Molina Healthcare of Florida approaches CPT 95990 (Pain Pump — Refill (by clinician)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.

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Coverage Covered
Prior auth No prior auth
Last reviewed 2026-05-06
Policy numberMolina MCP — Intrathecal Pump Refill

Criteria summary

High-level themes from the Molina Healthcare of Florida policy of record for CPT 95990. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: Molina Clinical Policy — Implanted Intrathecal Drug Delivery Systems (Pain Pumps) (adopted by Molina Healthcare of Florida Medicaid)

See the full Molina Healthcare of Florida criteria.

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