Spinal Cord Stimulation

Spinal cord stimulation (percutaneous dorsal column trial followed by implantation if successful) is covered for FBSS with significant radicular pain, CRPS (Budapest criteria), inoperable chronic ischemic limb pain from peripheral vascular disease, last‑resort moderate‑severe (≥5/10) chronic neuropathic pain present ≥12 months (e.g., lumbosacral arachnoiditis, phantom limb, diabetic neuropathy, post‑herpetic neuralgia, etc.), and for intractable angina meeting angiographic/ischemia criteria. Coverage requires multidisciplinary evaluation including psychological clearance and no untreated substance use disorder, failed conservative therapies ≥6 months, documented objective pathology and ODI ≥21%, a 3–7 day trial with ≥50% pain reduction prior to implantation (for angina also angiographic disease, unsuitable for revascularization, ≥1 month optimal pharmacotherapy with ≥2 antianginals, NYHA III/IV, and reversible ischemia); SCS is contraindicated with pacemakers/defibrillators and replacing a functioning standard stimulator with high‑frequency/burst/DTM is not medically necessary.