CPT 95991 · Intrathecal Pump · Medicare (Novitas MAC) — TX
Pain Pump — Refill w/ Reprogramming at Medicare (Novitas MAC) — TX.
How Medicare (Novitas MAC) — TX 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 (Novitas MAC) — TX 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 (Novitas MAC) — TX criteria.
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