Spinal Cord, Peripheral Nerve, and Percutaneous… | Ambetter

Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation

Ambetter · PayerPolicy · AMBETTER-CP-MP-117

Status: Active
Last checked by Backwork: October 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Ambetter before submitting.

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
0720T	CPT	Covered
63650	CPT	Covered
63655	CPT	Covered
63685	CPT	Covered
64555	CPT	Covered
64575	CPT	Covered
64585	CPT	Covered
64590	CPT	Covered
64595	CPT	Covered
64596	CPT	Covered
64597	CPT	Covered
64598	CPT	Covered
64999	CPT	Covered
95970	CPT	Covered
95971	CPT	Covered
95972	CPT	Covered
L8678	HCPCS	Covered
L8679	HCPCS	Covered
L8680	HCPCS	Covered
L8681	HCPCS	Covered
L8682	HCPCS	Covered
L8683	HCPCS	Covered
L8685	HCPCS	Covered
L8686	HCPCS	Covered
L8687	HCPCS	Covered
L8688	HCPCS	Covered