CPT L8680 · SCS · Fidelis Care NJ (Centene) — NJ Medicaid

SCS Lead (HCPCS) at Fidelis Care NJ (Centene) — NJ Medicaid.

How Fidelis Care NJ (Centene) — NJ Medicaid approaches CPT L8680 (SCS Lead (HCPCS)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.

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Coverage Covered

Prior auth Prior auth required

Last reviewed 2026-05-06

Policy numberEvolent IPM 2025 + Fidelis NJ Medicaid Provider Manual

Criteria summary

High-level themes from the Fidelis Care NJ (Centene) — NJ Medicaid policy of record for CPT L8680. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: 2025 Evolent (NIA) Interventional Pain Management Clinical Guidelines — adopted by Fidelis Care NJ Medicaid; Fidelis NJ Provider Manual delegates outpatient IPM UM to Evolent / NIA

See the full Fidelis Care NJ (Centene) — NJ Medicaid criteria.

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SCS Lead (HCPCS) at Fidelis Care NJ (Centene) — NJ Medicaid.

Criteria summary

See the full Fidelis Care NJ (Centene) — NJ Medicaid criteria.

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