Does L8680 require prior authorization?

Yes, L8680 requires prior authorization (high confidence). Code explicitly requires prior authorization.

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`L8680`, Implantable neurostimulator electrode, each

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Documentation Required

Clinical documentation may be required to support a service request.
Preauthorization is required for notification purposes only when CPT 62320 and 62322 are used for post-procedural pain.
Documentation must show medical necessity with conservative management and at least one complementary conservative treatment strategy.
All imaging must be read by an independent radiologist.
Medical record must contain documented history and careful screening, including multidisciplinary evaluation and both psychological and physical assessments, available on request.
All trials that proceed to permanent implants must have adequate chart documentation demonstrating trial effectiveness and the medical rationale for permanent implantation.

Key Coverage Criteria

Pulmonary hypertension;or
Documented ischemic heart disease;or
Impaired cognition or mood disorders;or
History of stroke;or
Hypertension;or
Ischemic heart disease or history of stroke;or

20 Active Policies

PALMETTO-JJ-L37632, Spinal Cord Stimulators for Chronic Pain

PALMETTO-JM-L37632, Spinal Cord Stimulators for Chronic Pain

ANTHEM-SURG.00026, Deep Brain, Cortical, and Cerebellar Stimulation

ANTHEM-SURG.00112, Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)

ANTHEM-CG-SURG-70, Gastric Electrical Stimulation

ANTHEM-CG-SURG-95, Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence

ANTHEM-CG-SURG-120, Vagus Nerve Stimulation

ANTHEM-CG-MED-79, Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-844835841DE9, Cigna Commercial Interventional Pain Management Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-47DEF0053A7B, Cigna Commercial Sleep Management Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-47F76AA38AE6, Cigna Medicare Advantage Interventional Pain Management Code List - Effective 01/01/2025

ANTHEM-SURG.00158, Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

ANTHEM-SURG.00129, Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring

CARELON-interventional-pain-management-2024-06-30-for-ohio-medicaid, Interventional Pain Management

CARELON-interventional-pain-management-2025-07-26-for-anthem-bc-ca-commercial, Interventional Pain Management

CARELON-interventional-pain-management-2026-06-14, Interventional Pain Management

CARELON-sleep-disorder-management-2024-10-20-updated-2025-07-01-for-anthem-bcbs-ohio-medicaid-and-regence-only-deferred-to-2025-12-01, Sleep Disorder Management

CARELON-sleep-disorder-management-2025-11-15-updated-2026-07-01, Sleep Disorder Management

UHCMA-POL-UHC_MA-deep-brain-responsive-cortical-stimulation, Deep Brain and Responsive Cortical Stimulation

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L8680, Implantable neurostimulator electrode, each