Does C1820 require prior authorization?

Yes, C1820 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

`C1820`, Generator, neurostimulator (implantable), with rechargeable battery and

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Voiding diaries documenting baseline and test-stimulation outcomes are required to measure the ≥50% improvement for urinary indications.
For fecal incontinence, documentation must show frequency (>2 incontinent episodes/week), duration (>6 months or >12 months after vaginal childbirth), and failure or intolerance of conventional therapies.
A percutaneous test stimulation report documenting at least 50% sustained (>1 week) improvement is required to support permanent implantation for fecal incontinence.
Medical records must document that the patient is refractory to conventional therapy (behavioral, pharmacologic and/or surgical) for urinary indications and is an appropriate surgical candidate able to undergo anesthesia.
Records must document that the condition is not related to excluded causes (anorectal malformation, pelvic radiation sequelae, active anal abscess/fistula, chronic IBD, neurologic causes) when claiming coverage for fecal incontinence.
Claims must be supported by medical record documentation demonstrating that the service meets the LCD L39543 indications and limitations and general CMS medical necessity requirements.

Sacral nerve stimulation (SNS) is covered for urinary urge incontinence.
SNS is covered for urgency-frequency syndrome (urinary urgency-frequency).
SNS is covered for urinary retention.
Both a temporary test stimulation and subsequent permanent implantation of an implanted sacral electrode array are covered for appropriate candidates.
SNS is covered for fecal incontinence when all fecal-specific criteria are met (see limitations/frequency): chronic fecal incontinence with >2 incontinent episodes/week and duration >6 months or >12 months after vaginal childbirth.
Coverage for fecal incontinence requires documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).

PALMETTO-JJ-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

PALMETTO-JM-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

CIGNA-0391, Diaphragmatic/Phrenic Nerve Stimulation

A53359, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A59332, Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

AETNA-CPB-0755, Motor Cortex Stimulation

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

BCBSIL-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSIL-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

BCBSMT-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSMT-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

BCBSNM-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSNM-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

BCBSOK-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

CARELON-interventional-pain-management-2024-01-01, Interventional Pain Management

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

CARELON-interventional-pain-management-2025-07-26, Interventional Pain Management

BCBSOK-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

REGENCE-SUR174, Occipital Nerve Stimulation

Ask Verity about documentation requirements, denial risks, or coverage in your state.

C1820, Generator, neurostimulator (implantable), with rechargeable battery and

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Voiding diaries documenting baseline and test-stimulation outcomes are required to measure the ≥50% improvement for urinary indications.
For fecal incontinence, documentation must show frequency (>2 incontinent episodes/week), duration (>6 months or >12 months after vaginal childbirth), and failure or intolerance of conventional therapies.
A percutaneous test stimulation report documenting at least 50% sustained (>1 week) improvement is required to support permanent implantation for fecal incontinence.
Medical records must document that the patient is refractory to conventional therapy (behavioral, pharmacologic and/or surgical) for urinary indications and is an appropriate surgical candidate able to undergo anesthesia.
Records must document that the condition is not related to excluded causes (anorectal malformation, pelvic radiation sequelae, active anal abscess/fistula, chronic IBD, neurologic causes) when claiming coverage for fecal incontinence.
Claims must be supported by medical record documentation demonstrating that the service meets the LCD L39543 indications and limitations and general CMS medical necessity requirements.

Sacral nerve stimulation (SNS) is covered for urinary urge incontinence.
SNS is covered for urgency-frequency syndrome (urinary urgency-frequency).
SNS is covered for urinary retention.
Both a temporary test stimulation and subsequent permanent implantation of an implanted sacral electrode array are covered for appropriate candidates.
SNS is covered for fecal incontinence when all fecal-specific criteria are met (see limitations/frequency): chronic fecal incontinence with >2 incontinent episodes/week and duration >6 months or >12 months after vaginal childbirth.
Coverage for fecal incontinence requires documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).