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Overview
A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Spinal cord stimulators require two procedures:
The Trial AND
The Permanent Implantation
Additional Information
Spinal cord stimulators should be reserved as a last resort for pain management.
These requests should almost always be done in an outpatient setting. Exception: If there is an additional request associated with the stimulator request that meets inpatient criteria.
You do not need to indicate laterality for these requests.
For each lead intended for the procedure, there should be an individual procedure code, "63650" entered in the Cohere Portal.
Dorsal Root Ganglion Stimulation (DRG) requests do not meet Humana Medicare criteria and will pend or be denied.
Documents to Include
Depending on the procedure codes entered for authorizations, the following documentation may be required. In very few circumstances, additional information that is not listed may be requested.
For every authorization, regardless of service, clinical documentation MUST include TWO (2) patient identifiers:
Either full name and date of birth; OR
Full name and health plan member ID (we cannot accept the patient's medical record number as an identifier because we do not have that information available when completing reviews)
This information should be included either on all pages of the document or on the first page of the document with other pages in continuation of the first page (ex: 1/10, 2/10, 3/10, etc)