Implantable Infusion Pumps for Pain or Spasticity - Medicare Advantage

This policy addresses implantable infusion pumps (implantable drug delivery/targeted drug delivery systems delivering medication via intrathecal catheter) for management of chronic pain and spasticity. Coverage is subject to Medicare reasonable-and-necessary determinations and applicable NCD 280.14/LCD L33461 and contractor (Noridian/CGS/Palmetto) rules—including MAC jurisdictional requirements and other medical-necessity and patient-selection criteria found in the full LCD/contractor articles.

"Clinical documentation that the existing device cannot be repaired, or that the patient's condition has changed making the present device nonfunctional."

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