CMM-210: Implantable Intrathecal Drug Delivery Systems

Covered: implantable intrathecal or epidural drug delivery systems are medically necessary for nonmalignant chronic intractable pain, severe refractory spasticity/chronic dystonia, and cancer-related pain when specified criteria are met; excluded are obstetrical/surgical epidural anesthesia and uses for injectates outside scope (e.g., Spinraza, chemotherapy, neurolytics, biologics) or any indications not meeting the criteria (deemed experimental). Key requirements: documented objective pathology and prior-treatment failure (≥6 months of provider-directed noninvasive care including rehab and scheduled analgesics for nonmalignant pain; ≥6 weeks oral antispasmodics plus PT or meeting baseline Ashworth/spasm thresholds for spasticity), behavioral health attestation of no uncontrolled mental/substance issues, agreement to a 50% systemic opioid reduction before intrathecal opioid trials, documented positive trial responses (>50% pain reduction for 8 hours with improved function for permanent implants; ≥2‑point Ashworth/Spasm reduction for 4 hours after intrathecal baclofen), and pump replacement only if battery is near end-of-life/unrepairable with no evidence of abuse or neglect.