Implanted Spinal Drug Delivery Systems – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers epidural/intrathecal drug infusion trials and implanted spinal drug delivery systems (and replacements) for cancer-related pain, severe spasticity, and selected chronic non‑malignant pain when InterQual and policy criteria are met; the policy does not address individuals <18 years. Key requirements for chronic non‑malignant pain: age >18, known etiology, further surgery not indicated or refused, ≥6 months of failed conservative therapy, no untreated psychological/social issues, a required successful infusion trial with ≥50% pain reduction for permanent implantation, and replacements only if prior criteria were met and the device is nonfunctional or out of warranty.

"Epidural or intrathecal drug infusion trial or catheter pump placement for cancer-related pain is proven and medically necessary in certain circumstances. For medical necessity clinical coverage cr..."