HCPCS Level II › C codes C1607 Neurostim integ rechgNeurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Payer policies and prior authorization for C1607 16 of 16 payer prior-auth lists that name C1607 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), CarePlus Health Plans, Cigna, Humana.
Payer Plan State Prior auth Conditions Since Source Blue Cross Blue Shield of Arizona (AZ Blue) AZ Blue-administered Medicare Advantage (M2K) AZ prior auth required Sep 1, 2026 AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) Standard PA code list (most commercial plans) AZ prior auth required Sep 1, 2026 AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) State of Arizona employee group (SYD, S3Z) AZ prior auth required Sep 1, 2026 State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) Teamsters group (TYW) AZ prior auth required Sep 1, 2026 Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Jan 1, 2026 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Jan 1, 2026 Master Precertification List (For Health Care Providers) Cigna Other Services All prior auth required Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs Cigna Other Services All prior auth required Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Other Services CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Payer coverage policies that name C1607 C1607 appears in 14 coverage policies from Aetna, Anthem, Blue Shield of California, Cigna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Deep Brain Stimulation (0208) covered if criteria are met Mar 27, 2026 payer document Aetna Diabetic Neuropathy: Selected Treatments (0729) covered if criteria are met Feb 24, 2026 payer document Aetna Fecal Incontinence (0611)Acticon neosphincter covered if criteria are met Sep 23, 2026 payer document Aetna Motor Cortex Stimulation (0755) not covered Feb 24, 2026 payer document Aetna Parkinson's Disease (0307) not covered Feb 24, 2026 payer document Aetna Spasticity Management (0362) not covered May 26, 2026 payer document Aetna Spinal Cord Stimulation (0194) covered if criteria are met Sep 10, 2026 payer document Aetna Tourette's Syndrome (0480)Ecopipam, pramipexole, VMAT-2 inhibitors (e.g., valbenazine), amphetamines, Deutetrabenazine (Austedo) not covered Jul 24, 2026 payer document Aetna Trigeminal Neuralgia: Treatments (0374)Topical ambroxol, Erenumab, Intravenous ketamine not covered Jun 29, 2026 payer document Aetna Urinary Incontinence (0223) covered if criteria are met Jul 16, 2026 payer document Anthem Vagus Nerve Stimulation (CG-SURG-120) not covered Feb 19, 2026 payer document Blue Shield of California Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions (1.01.31) listed, no stance payer document Cigna Vagus Nerve Stimulation (VNS) (0350) not covered Feb 15, 2026 payer document Premera Blue Cross Non-covered Experimental/Investigational Services listed, no stance Oct 1, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IN.
ND: $0.00 (physician), effective Aug 1, 2026 TX: $14096.73 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme)), effective Jan 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.