CMM-210: Implantable Intrathecal Drug Delivery Systems

Implantable intrathecal/epidural drug delivery systems are covered for nonmalignant chronic intractable pain, severe refractory spasticity/chronic dystonia, and cancer-related pain (not for obstetrical/surgical anesthesia) and are considered experimental/unproven for other indications including intrathecal insulin, antibiotics for osteomyelitis, heparin, or drugs not FDA‑approved for the intended use. Coverage requires documented percutaneous intrathecal/epidural trials (single bolus or catheter infusion) with specific response thresholds — ≥50% pain reduction and functional improvement for permanent implants (after ≥6 months failed noninvasive management and agreement to reduce systemic opioids by 50% for nonmalignant pain), ≥2‑point Ashworth/Spasm Frequency improvement after baclofen trial for spasticity (trial may be omitted in advanced cancer with limited survival/high procedural risk) — plus specified documentation, and pump replacement only when battery/end‑of‑life or irreparable failure is documented without evidence of abuse.