CMM-211: Spinal Cord Stimulators

Covers short-term (>48 hr) SCS trials and permanent implantation (low‑frequency SCS, with HF10 allowed only for FBSS) for FBSS with intractable neuropathic leg pain, CRPS/RSD, chronic critical limb ischemia, and chronic stable angina when criteria are met; other indications, peripheral/DRG/PNS stimulation, and HF SCS for non‑FBSS uses are investigational/not covered, and replacement of a functioning low‑frequency SCS with a high‑frequency device is not medically necessary. Key requirements: documented failure of conservative/surgical management (≥6 months conservative care for FBSS/CRPS; failed multidisciplinary/surgical care for CLI; CCS III–IV CAD not amenable to revascularization and failed optimal anti‑anginal therapy for angina), a >48‑hour trial with objective benefit (≥50% pain reduction for FBSS/CRPS; clinically beneficial response for CLI/angina) before permanent implant, a face‑to‑face mental health evaluation showing no uncontrolled psychiatric issues, cardiologist attestation for angina, and replacement only for malfunctioning/unrepairable/out‑of‑warranty devices.