January 1, 2006

 

 

TO:                 Physicians, Osteopaths, Anesthesiologists, Mid-level Practitioners, Hospitals, and Ambulatory Surgical Centers

 

FROM:          Leslie M. Clement, Deputy Administrator

 

SUBJECT:     CHANGES IN PRIOR AUTHORIZATION REQUIREMENTS FOR SPINAL NEUROSTIMULATORS

 

Effective for dates of service on or after 02/01/2006, prior authorization will be required for implantation of spinal neurostimulators. This includes all services, supplies, facility, and ancillary charges related to implantation of spinal neurostimulators with the following codes:

 

·        ICD-9 Procedures and Interventions code 03.93, (Implantation or replacement of spinal neurostimulator lead(s), including all services related to inpatient, outpatient, and ambulatory surgical center charges for services.

·        CPT procedure codes 63650, 63655, 63660, 63685, and 63688

 

 

 

 

ð      other, less invasive procedures that are contraindicated, or have been attempted without success;

ð      client has received a multidisciplinary team screening and evaluation;

ð      client has received a psychological evaluation; and

ð      when requesting prior authorization for permanent implanted spinal neurostimulators, document that relief of pain has been demonstrated with a temporary implanted electrode(s).

 

This information release changes information in the following section(s) of the Idaho Medicaid Provider Handbook: 

Physician/osteopath handbook, Section 3.3.3.6, which is available online at: http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s3_004_005_physician.pdf

Hospital handbook, Section 3.4.13 through 3.4.15, which is available online at:

 

If you have questions concerning this Information Release, please contact Arla Farmer, Bureau of Medical Care, at (208) 364-1958 or by FAX at (208) 332-7285.

 

Thank you for your continuing participation in the Medicaid Program.

 

LC/af