CG-SURG-126 Tibial Nerve Stimulation

This policy addresses tibial nerve stimulation, including percutaneous, implantable, and transcutaneous approaches, for urinary symptoms. Anthem covers an initial 12‑week trial of percutaneous tibial nerve stimulation when urinary urge incontinence, urinary urgency/frequency, or non‑obstructive urinary retention has been present for at least 3 months and is not due to a neurologic condition. Percutaneous or implantable tibial nerve stimulation (including replacement/revision) is not covered if criteria are not met, and transcutaneous tibial nerve stimulation is not covered for any indication.

"An initial 12-week trial ofpercutaneoustibial nerve stimulation is consideredmedically necessarywhen the following criteria are met (AandB):"

Sign up to see full coverage criteria, indications, and limitations.