Peripheral Nerve Stimulation (PNS) And Peripheral Nerve Field Stimulation (PNFS)

This policy governs peripheral nerve stimulation (PNS) and peripheral nerve field stimulation (PNFS) for adults with severe, intractable chronic peripheral neuropathic or mixed somatic/neuropathic pain—including focal posttraumatic or postsurgical neuralgia—who have failed conservative therapies. Major requirements/limitations: treatment is limited to back and extremities (not craniofacial), permanent implantation requires a successful percutaneous trial with ≥50% pain reduction (trial per FDA labeling limited to up to 30 days; some temporary uses cleared up to 60 days), coverage is subject to the member’s benefit plan, and certain PNS/PNFS indications remain experimental/investigational and may be excluded.

"Neuromodulation (including PNS/PNFS) for chronic pain that is refractory to other treatment modalities"

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