CMM-211: Spinal Cord Stimulators

CMM‑211 covers short-term (>48‑hour) trials and permanent implantation of low‑frequency (and HF10 where specified) spinal cord stimulators for refractory FBSS with neuropathic leg pain, CRPS/RSD, chronic critical limb ischemia, and chronic stable angina, while deeming other indications (e.g., post‑amputation pain, post‑herpetic neuralgia, peripheral neuropathy), peripheral nerve/DRG stimulation, and replacement of a functioning low‑frequency SCS with high‑frequency SCS experimental/not covered or not medically necessary. Coverage requires documentation of prior conservative management failure (≥6 months for FBSS/CRPS), a face‑to‑face mental health evaluation showing no uncontrolled psychiatric issues, a trial benefit (≥50% pain reduction for FBSS/CRPS; a demonstrated beneficial response for CLI/angina), and case‑by‑case medical necessity determination.

"Trial duration documented as greater than 48 hours (short-term trial)."