CMM-211: Spinal Cord and Dorsal Root Ganglion Stimulation

Covers >48‑hour short-term trials and permanent spinal cord stimulator (SCS) implants (and limited SCS/DRG replacements) for FBSS with neuropathic leg pain, extremity‑limited CRPS/RSD, chronic critical limb ischemia, and chronic stable angina, while excluding DRG stimulation except for specified replacements, disallowing high‑frequency SCS except for FBSS, and deeming many other pain indications (e.g., post‑amputation pain, post‑herpetic neuralgia, diabetic neuropathy, peripheral nerve stimulation, burst modes) not medically necessary. Key requirements: strict diagnostic and imaging criteria, specialist attestations, behavioral‑health clearance, failure of conservative therapy (typically ≥6 months where specified), a short‑term trial >48 hours, and for most permanent implants documentation of ≥50% pain reduction during the trial (or a documented beneficial response for angina); repeat trials after a failed initial trial are not covered.

"Chronic, intractable pain secondary to Failed Back Surgery Syndrome (FBSS) with intractable neuropathic leg pain (after prior surgery in the same spinal region) — short-term trial (i."