CMM-210: Implantable Intrathecal Drug Delivery Systems

Implantable intrathecal or epidural drug delivery systems are covered as medically necessary for nonmalignant chronic intractable pain, severe refractory spasticity/chronic dystonia, and cancer-related pain when specified trial and documentation criteria are met, are considered experimental/unproven for other indications, do not apply to obstetrical/surgical epidural anesthesia, and pump replacement is only covered for end‑of‑battery/irreparable failure (not when components remain functional). Key requirements include documented objective pathology, failure of conservative therapy (generally ≥6 months for nonmalignant pain; ≥6 weeks of oral antispasmodics plus PT for spasticity), a behavioral health attestation, agreement to a 50% systemic opioid reduction before intrathecal opioid trials, and meeting trial-response thresholds for permanent implantation (e.g., >50% pain reduction for 8 hours or ≥2‑point Ashworth/Spasm reduction for 4 hours), with trials possibly omitted in advanced cancer/high procedural risk.