Procedure billing guide

Spinal Cord Stimulator (SCS) Billing and Coding

Spinal cord stimulator (SCS) billing covers two stages. The trial places percutaneous leads with CPT 63650 (per lead). The permanent implant adds the pulse generator with 63685. Revisions, removals and device programming (95970 to 95972) are billed separately. Payers usually require prior authorization, a psychological evaluation and a successful trial before approving a permanent implant.

Updated October 12, 2026

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CPT codes

What are the CPT codes for spinal cord stimulators?

Code	Description
63650	Percutaneous implantation of neurostimulator electrode array (lead), epidural, per lead
63655	Laminectomy for implantation of paddle electrode, epidural
63661, 63662	Removal of percutaneous or paddle electrode arrays
63663, 63664	Revision or replacement of percutaneous or paddle electrode arrays
63685	Insertion or replacement of spinal neurostimulator pulse generator
63688	Revision or removal of spinal neurostimulator pulse generator
95970 to 95972	Neurostimulator analysis and programming

Codes shown for reference. Always confirm against the current year’s CPT code set and your payer’s policy.

Billing rules

How do you bill a spinal cord stimulator?

What do payers require before a permanent spinal cord stimulator?

Before approving a permanent implant, payers usually want chronic pain that has not responded to other treatment, a psychological evaluation clearing the patient, and a successful trial, most often defined as at least 50 percent pain relief. The trial and the permanent implant each need their own prior authorization.

Chronic pain that has not responded to other treatment
A psychological evaluation clearing the patient for implant
A successful trial, usually defined as at least 50 percent pain relief
Prior authorization for the trial and again for the permanent implant

Do spinal cord stimulators need prior authorization under WISeR?

In six states, yes. Since 2026, Medicare's WISeR model has required prior authorization for electrical nerve stimulators, including spinal cord stimulators, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Medicare Advantage and commercial plans commonly require it everywhere, for both the trial and the permanent implant.

How do you code a spinal cord stimulator correctly?

Bill 63650 once per lead, so a two-lead trial is two units, and add 63685 for the pulse generator at the permanent implant. Device billing depends on the place of service, programming codes depend on how complex the programming was, and trial results must be documented clearly to support the implant.

63650 is billed per lead, so a two-lead trial is billed with two units
Device (HCPCS L-code) billing depends on place of service: in a facility, the device is usually included in the facility payment
Programming codes depend on the complexity of the programming performed
Document trial results clearly, since they decide whether the implant is approved

Common denials

Why are spinal cord stimulator claims denied?

These are the denial reasons we see most often. We check for each one before a claim goes out, instead of finding out from a denial.

Denials we prevent

Missing psychological evaluation
Trial results not documented or below the payer's threshold
Permanent implant performed under the trial authorization
Device billed in a setting where it is already paid to the facility

FAQ

Spinal Cord Stimulation questions

What is the CPT code for a spinal cord stimulator trial?

A percutaneous SCS trial is billed with CPT 63650 for each lead placed.

What CPT code is used for a permanent spinal cord stimulator implant?

The permanent pulse generator is billed with CPT 63685, along with 63650 or 63655 for the permanent leads.

Does Medicare require prior authorization for spinal cord stimulators?

In the six WISeR states, including New Jersey, traditional Medicare has required prior authorization for electrical nerve stimulators since 2026. Medicare Advantage and commercial plans commonly require it everywhere.

Sources

Coverage rules change; always check the current version of each policy and your payer’s own rules.

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