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Chronic non-cancer pain is managed with a range of pharmacological, physical, psychological and surgical modalities. Peripheral nerve stimulation or neuromodulation has been proposed as a non-destructive surgical option for patients with refractory neuropathic pain affecting the trunk or limbs.
Use of a peripheral nerve stimulator involves implantation of electrodes around a selected peripheral nerve (e.g., radial, sciatic, ilioinguinal). The stimulating electrode is connected by an insulated lead to a receiver unit which is implanted under the skin at a depth not greater than 1/2 inch. Stimulation is induced by a generator connected to an antenna unit which is attached to the skin surface over the receiver unit.
As with other types of implantable nerve stimulation, implantation of the peripheral nerve stimulator is typically a two-step process. Initially, the electrode is temporarily implanted, allowing a trial period of stimulation. Once treatment effectiveness is confirmed (defined as at least 50% reduction in pain), the electrodes and radio-receiver/ transducer are permanently implanted.
Peripheral nerve (regional) field stimulation is a relatively recent application of peripheral neuromodulation. This type of stimulation, which involves placement of a stimulating electrode subcutaneously in the area of maximum pain, has been proposed as a treatment of low back pain.
The U. S. Food and Drug Administration (FDA) has approved the StimQ Peripheral Nerve Stimulator (PNS) system for use in adults with “severe intractable chronic pain of peripheral origin, as the sole mitigating agent, or as an adjunct to other modes of therapy used in a multidisciplinary approach.” Another device, the StimRouter Neuromodulation System, gained 510(k) clearance for “pain management in adults who have severe intractable chronic pain of peripheral nerve origin, as an adjunct to other modes of therapy (e.g., medications).” The SPRINT peripheral nerve stimulation device received FDA clearance as a temporary implant for the treatment of post-traumatic pain, post-operative pain, and chronic, intractable pain.
NOTE: Occipital Nerve Stimulation is addressed separately in policy II-140.
Peripheral nerve stimulation of the trunk or limbs, including but not limited to stimulation of the radial, sciatic, and ilioinguinal nerves, is considered EXPERIMENTAL/INVESTIGATIVE for the treatment of all acute and chronic pain indications due to a lack of evidence demonstrating its impact on improved health outcomes.
Peripheral nerve (regional) field stimulation is considered EXPERIMENTAL/INVESTIGATIVE for the treatment of chronic pain due to a lack of evidence demonstrating its impact on improved health outcomes.
No additional statements.
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Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2022. All rights reserved.
CDT codes copyright American Dental Association® 2022. All rights reserved.