Sacral Nerve Neuromodulation/Stimulation

This policy covers sacral nerve neuromodulation/stimulation (including a percutaneous/temporary trial and permanent implant) for select urinary disorders—urge incontinence, overactive bladder, nonobstructive urinary retention—and for chronic fecal incontinence/nonobstructive fecal retention. Coverage requires documented failure or intolerance of ≥2 conservative therapies, that the patient is an appropriate surgical candidate, and a trial stimulation showing ≥50% symptom improvement over at least 48 hours; treatment is excluded for neurologic causes, certain anorectal malformations/recent rectal surgery, and is considered investigational for conditions such as chronic constipation or chronic pelvic pain.

"Sacral nerve neuromodulation/stimulation for treatment of urinary incontinence"

Sign up to see full coverage criteria, indications, and limitations.