Spinal Cord Stimulators for Chronic Pain

SCS therapy (percutaneous trial and, if successful, permanent implantation) is covered for chronic intractable pain—primarily neuropathic—only when a documented successful trial is achieved; patients with active substance abuse, failed trials (unless extenuating circumstances), more than 2 trials per anatomic spinal region per lifetime, or placement of >2 leads/16 contacts are not considered reasonable/covered. Coverage requires multidisciplinary screening including psychological evaluation, documented patient education/informed consent, trial response of ≥50% pain or analgesic reduction plus functional improvement, permanent implants performed in an ASC or hospital (temporary trials may be done in-office only if proper sterility, equipment, support and privileges exist), replacements do not require repeat trials, and physicians with trial-to-permanent ratios <50% may be subject to audit.

"The implantation of spinal cord stimulators (SCS) may be covered as therapies for the relief of chronic intractable pain."