Diaphragmatic/Phrenic Nerve Stimulation

This policy covers diaphragmatic/phrenic nerve stimulation (diaphragm pacing) as an alternative to mechanical ventilation for adults with chronic ventilatory insufficiency or failure from bilateral diaphragmatic paralysis or severe paresis, high cervical (≥C3) spinal cord injury, central alveolar hypoventilation, and select ALS patients meeting eligibility criteria. Coverage requires demonstrable diaphragm movement with stimulation (fluoroscopy/ultrasound), intact phrenic nerve/lung/diaphragm function, ability to sustain ≥4 continuous hours off the ventilator, adherence to device‑specific FDA HDE/HUD indications (e.g., NeuRx RA/4 ALS patients generally ≥21 years with FVC ≥45% predicted), and other uses are investigational or excluded.

"Medically necessary to eliminate or reduce the need for mechanical ventilator support in patients with chronic ventilatory insufficiency or failure due to bilateral diaphragmatic paralysis or sever..."