CPT 95991 · Intrathecal Pump · Health Partners Plans / Jefferson Health Plans — PA HealthChoices
Pain Pump — Refill w/ Reprogramming at Health Partners Plans / Jefferson Health Plans — PA HealthChoices.
How Health Partners Plans / Jefferson Health Plans — PA HealthChoices approaches CPT 95991 (Pain Pump — Refill w/ Reprogramming) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.
Free with practitioner sign-in — magic-link email auth, no credit card.
eviCore IT Drug DeliveryCriteria summary
High-level themes from the Health Partners Plans / Jefferson Health Plans — PA HealthChoices policy of record for CPT 95991. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
See the full Health Partners Plans / Jefferson Health Plans — PA HealthChoices criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →