Rubrica

CPT 95990 · Intrathecal Pump · Wellpoint of New Jersey — NJ Medicaid

Pain Pump — Refill (by clinician) at Wellpoint of New Jersey — NJ Medicaid.

How Wellpoint of New Jersey — NJ Medicaid 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 numberCarelon IPM (MSK01) / Anthem CG-SURG-15 (related)

Criteria summary

High-level themes from the Wellpoint of New Jersey — NJ Medicaid 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: Anthem Medical Policy / Carelon IPM — Intrathecal Drug Delivery (Pain & Spasticity)

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