CMM-211: Spinal Cord Stimulators

eviCore covers short-term trials (>48 hrs) and permanent implantation of non‑high‑frequency dorsal column spinal cord stimulators for failed back surgery syndrome with neuropathic leg pain, CRPS/RSD, chronic critical limb ischemia, and chronic stable angina (with high‑frequency SCS allowed only for FBSS), while dorsal root ganglion stimulation, burst modes, peripheral nerve stimulation, high‑frequency SCS for other indications, and SCS for other pain conditions are considered experimental, investigational, or not medically necessary. Key requirements include documentation of failure of physician‑supervised conservative management (generally ≥6 months where specified), a mental health evaluation showing no uncontrolled psychiatric/substance issues, a >48‑hour trial demonstrating ≥50% pain reduction for permanent implantation (or other documented beneficial response for CLI/angina), and condition‑specific documentation (e.g., CRPS diagnostic criteria, cardiology attestation for angina).