LCDActive
Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence
L39543
Effective: November 5, 2023
Updated: December 31, 2025
Policy Summary
Sacral nerve stimulation (SNS) is covered for urinary urge incontinence, urgency-frequency syndrome, and nonobstructive urinary retention, and for fecal incontinence when specific criteria are met. Coverage requires prior failure of conventional therapies, demonstration of surgical candidacy, a successful test stimulation with ≥50% improvement (sustained >48 hours for FI), and documentation (voiding/bowel diaries and test results); SNS is investigational for chronic constipation and chronic pelvic pain and excluded for certain anatomic or neurologic causes of incontinence.
Coverage Criteria Preview
Key requirements from the full policy
"SNS is covered for treatment of urinary urge incontinence."
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