CMS removes two codes from prior authorization list

CPT^® codes 63685 (insertion or replacement of spinal neurostimulator pulse generator or receiver) and 63688 (revision or removal of implanted spinal neurostimulator pulse generator or receiver) are temporarily removed from the list of services that require Medicare prior authorization when performed in a hospital outpatient department, CMS announced on May 13. For implanted spinal neurostimulators, only 63650 (implantation of spinal neurostimulator electrodes, accessed through the skin) requires prior authorization.

However, if the trial is rendered in a setting other than the outpatient department, providers will need to request prior authorization for 63650 as part of the permanent implantation procedure in the hospital outpatient department, according to CMS.

CMS did not comment on whether or when 63685 or 63688 may be added back to the prior authorization list. Organizations should continue to monitor CMS communications about prior authorizations.

See the full list of codes requiring prior authorization here.