Does C1897 require prior authorization?

Yes, C1897 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`C1897`, Lead, neurostimulator test kit (implantable)

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.
Voiding diaries documenting baseline symptoms and demonstrating >=50% improvement during test stimulation must be included to support permanent implantation for urinary indications.
For fecal incontinence, documentation must include frequency of incontinent episodes, duration of symptoms (>6 months or >12 months post-vaginal childbirth), failure/intolerance of conventional therapy, and percutaneous test stimulation results showing >=50% sustained (>1 week) improvement.
Documentation must demonstrate the patient is an appropriate surgical candidate able to undergo implantation under anesthesia and must document exclusion of contraindicating conditions (e.g., anorectal malformation, IBD, neurologic causes) where applicable.
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.
Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.

Sacral nerve stimulation (direct stimulation via an electrode array implanted at the sacrum) is covered for treatment of urinary urge incontinence, urgency-frequency syndrome, and urinary retention.
Both temporary (test) stimulation and permanent implantation are covered when appropriate candidate criteria are met.
Patient must be refractory to conventional therapy for the urinary indication, defined as documented failure of behavioral, pharmacologic and/or surgical corrective therapy, and be an appropriate surgical candidate for implantation under anesthesia.
Before permanent implantation for urinary indications, the patient must demonstrate a >=50% improvement on test stimulation measured by voiding diaries and must be able to adequately record voiding diary data.
Sacral nerve stimulation is covered for fecal incontinence when chronic fecal incontinence has >2 incontinent episodes per week on average and duration is >6 months (or >12 months after vaginal childbirth).
For fecal incontinence, patient must have 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

A55835, 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

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

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

C1897, Lead, neurostimulator test kit (implantable)

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.
Voiding diaries documenting baseline symptoms and demonstrating >=50% improvement during test stimulation must be included to support permanent implantation for urinary indications.
For fecal incontinence, documentation must include frequency of incontinent episodes, duration of symptoms (>6 months or >12 months post-vaginal childbirth), failure/intolerance of conventional therapy, and percutaneous test stimulation results showing >=50% sustained (>1 week) improvement.
Documentation must demonstrate the patient is an appropriate surgical candidate able to undergo implantation under anesthesia and must document exclusion of contraindicating conditions (e.g., anorectal malformation, IBD, neurologic causes) where applicable.
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.
Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.

Sacral nerve stimulation (direct stimulation via an electrode array implanted at the sacrum) is covered for treatment of urinary urge incontinence, urgency-frequency syndrome, and urinary retention.
Both temporary (test) stimulation and permanent implantation are covered when appropriate candidate criteria are met.
Patient must be refractory to conventional therapy for the urinary indication, defined as documented failure of behavioral, pharmacologic and/or surgical corrective therapy, and be an appropriate surgical candidate for implantation under anesthesia.
Before permanent implantation for urinary indications, the patient must demonstrate a >=50% improvement on test stimulation measured by voiding diaries and must be able to adequately record voiding diary data.
Sacral nerve stimulation is covered for fecal incontinence when chronic fecal incontinence has >2 incontinent episodes per week on average and duration is >6 months (or >12 months after vaginal childbirth).
For fecal incontinence, patient must have documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).