Urinary Incontinence Devices and Treatments

This policy covers sacral neuromodulation (SNM/SNS), including short external trials and permanent implantation with U.S. FDA‑approved devices, and FDA‑approved urethral bulking agent injections for lower urinary tract dysfunction such as overactive bladder (urgency/frequency, urge incontinence), refractory urge incontinence, nonobstructive urinary retention, and stress urinary incontinence from intrinsic sphincter deficiency or post‑surgical/traumatic causes. Coverage requires symptoms ≥6 months causing significant disability, documented failure of appropriate conservative/second‑line therapies (bladder training, pelvic floor PT with biofeedback, pharmacologic treatment; for retention, intermittent self‑catheterization unless not tolerated), a successful percutaneous stimulation trial (≥50% symptom reduction) before permanent SNM, and use of FDA‑approved devices/agents; SNM and bulking are not covered for neurologic or obstructive causes or when criteria are unmet.