Non-Implantable Pelvic Floor Electrical Stimulator

Non-implantable pelvic floor electrical stimulation is covered for treatment of stress or urge urinary incontinence in cognitively intact patients only after a documented failed trial of pelvic muscle exercise training (no clinically significant improvement after 4 weeks of an ordered PME plan). Documentation must include the incontinence diagnosis, the ordered PME plan and its 4-week completion with failure outcome, and evidence the patient is cognitively intact. The policy applies to non-implantable stimulators; implantable devices are outside this policy's scope.

"Non-implantable pelvic floor electrical stimulation is covered for treatment of stress urinary incontinence or urge urinary incontinence in patients who are cognitively intact and who have failed a..."

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