Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation

This policy addresses spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS)/peripheral nerve field stimulation (PNFS) as palliative electrical therapies to reduce chronic or acute neuropathic and nerve‑origin pain and permits trials prior to permanent implantation, while percutaneous electrical nerve field stimulation (PENFS) and certain percutaneous approaches are considered investigational and not covered. Coverage is limited to selected populations—eg, failed back surgery syndrome (with prior lumbar surgery), complex regional pain syndrome, chronic ischemic leg pain and other refractory neuropathic pain that interferes with ADLs—only after ≥6 months of conventional multidisciplinary therapy, demonstration of cognitive ability to manage the device, psychological clearance (no uncontrolled mental health disorder), no untreated substance dependence, and other specified criteria, with some indications reviewed case‑by‑case.

"Peripheral nerve stimulation (PNS) to decrease chronic or acute pain by stimulating peripheral nerves with leads placed adjacent or parallel to the affected nerve"