Does L8680 require prior authorization?

Yes, L8680 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

`L8680`, Implantable neurostimulator electrode, each

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.
Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.

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-L37632, Spinal Cord Stimulators for Chronic Pain

PALMETTO-JM-L37632, Spinal Cord Stimulators for Chronic Pain

ANTHEM-SURG.00158, SURG.00158 Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

ANTHEM-CG-SURG-70, CG-SURG-70 Gastric Electrical Stimulation

ANTHEM-CG-SURG-95, CG-SURG-95 Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence

ANTHEM-CG-MED-79, CG-MED-79 Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

CIGNA-0391, Diaphragmatic/Phrenic Nerve Stimulation

UHC-POL-occipital-neuralgia-headache-treatment, Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)

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

A55835, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A56876, Billing and Coding: Spinal Cord Stimulators for Chronic Pain

UHC-POL-deep-brain-cortical-stimulation, Deep Brain and Cortical Stimulation

UHC-POL-electrical-stimulation-treatment-pain-muscle-rehabilitation, Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation

UHC-POL-implanted-electrical-stimulator-spinal-cord, Implanted Electrical Stimulator for the Spinal Cord

UHC-POL-obstructive-sleep-apnea-treatment, Obstructive and Central Sleep Apnea Treatment

ANTHEM-CG-SURG-120, CG-SURG-120 Vagus Nerve Stimulation

UHC-POL-sacral-nerve-stimulation, Sacral Nerve Stimulation for Urinary and Fecal Indications

UHC-POL-vagus-nerve-stimulation, Vagus and External Trigeminal Nerve Stimulation

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

ANTHEM-SURG.00112, SURG.00112 Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)

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

L8680, Implantable neurostimulator electrode, each

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.
Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.

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).