CPT 95991 · Intrathecal Pump · Medicare (Noridian JE MAC)
Pain Pump — Refill w/ Reprogramming at Medicare (Noridian JE MAC).
How Medicare (Noridian JE MAC) approaches CPT 95991 (Pain Pump — Refill w/ Reprogramming) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Clearway-MPG-PainPumpsCriteria summary
High-level themes from the Medicare (Noridian JE MAC) policy of record for CPT 95991. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Prior Intrathecal trial via percutaneous catheter or single-shot bolus documentation required (typically with ≥50% relief).
Source: Clearway Master Payer Guidelines v2025 — Pain Pumps
See the full Medicare (Noridian JE MAC) criteria.
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