Billing and Coding: Spinal Cord Stimulators for Chronic Pain

Coverage: Up to two temporary spinal cord stimulator trials per anatomic region (two per date of service or four units per patient per lifetime, with exceptions for technical limitations or different stimulation modalities/new technology); repeat trials are not appropriate except for documented extenuating circumstances, and services lacking documented medical necessity will be denied. Key requirements: clinical records must document diagnosis, prior therapies, imaging showing proper lead placement and medical necessity; physicians with a trial-to-permanent implant ratio <50% are subject to post-payment review and must supply requested documentation or face denial/recoupment, and applicable CCI coding edits apply.