Spinal Cord Stimulators for Chronic Pain
JE · Effective Oct 1, 2015
6 active Medicare policies list 63655, and 26 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
Free account. Policy pages stay open to everyone.
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
JJ · Effective Jan 29, 2018
JM · Effective Jan 29, 2018
National · Effective Jan 1, 2024
National · Effective Oct 16, 2025
26 policies from 16 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 63655 |
|---|---|---|
| Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments | Oct 5, 2023 | Covered |
| Headaches: Invasive Procedures | Feb 20, 2024 | Covered |
| Intraoperative Neurophysiological Monitoring | Oct 26, 2023 | Covered |
| Post-Herpetic Neuralgia | Feb 20, 2024 | Covered |
| Spasticity Management | Jun 21, 2023 | Covered |
| Spinal Cord Stimulation | Jul 13, 2023 | Covered |
| Vulvodynia and Vulvar Vestibulitis Treatments | Oct 26, 2023 | Covered |
|---|
| Policy | Effective | Status of 63655 |
|---|---|---|
| Cigna Commercial Interventional Pain Management Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation | Oct 1, 2026 | Covered |
| Implanted Electrical Stimulator for the Spinal Cord | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation | Oct 1, 2026 | Covered |
| Implanted Electrical Stimulator for the Spinal Cord | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation | Oct 1, 2026 | Covered |
| Implanted Electrical Stimulator for the Spinal Cord | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation | Not recorded | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Interventional Pain Management | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Cigna Medicare Advantage Interventional Pain Management Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of 63655 |
|---|---|---|
| EOCCO Pain Management Code List | May 1, 2026 | Prior auth required |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Health Alliance Plan MSK Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 63655 |
|---|---|---|
| Spinal Cord Stimulators for Chronic Pain | Not recorded | Covered |