Spinal Cord Stimulation

To ensure that a patient meets the medically necessary policy criteria, or to find out if prior authorization/pre-determination is required, please contact the patient's payer directly.

Coding

Commonly Billed Codes provide relevant billing and coding guidance. Included in the documents are procedure and device codes to be used when billing, along with Medicare National Average payment rates.

Note: Our Commonly Billed Codes state that the physician payment amounts are valid through February 28, 2010. On March 2, 2010, the president signed H.R. 4691, the Temporary Extension Act of 2010 into law. This legislation includes a provision that freezes Medicare physician payments at their current level until March 31, 2010.

Spinal Cord Stimulation for Chronic Pain of the Trunk or Limbs
  • ICD-9-CM Diagnosis and Procedure Codes
  • HCPCS II Device Codes
  • Device C-Codes and Device Edits
  • CPT® Procedure Codes
  • MS-DRG Assignments

Coverage

Use this form to submit a prior authorization request and start the prior authorization process.

Use this form to choose the level of service for prior authorizations.

This document contains information to help you prepare a clear and concise referral letter.

Sample cover letter template for obtaining prior authorization for SCS implant.

Sample cover letter template for obtaining prior authorization for SCS replacement.

Sample cover letter template for obtaining prior authorization for SCS trial.

Sample cover letter template for obtaining prior authorization for SCS trial and implant.

Sample appeal letter for coverage denial of spinal cord stimulation to treat chronic pain.

Customizable template for obtaining prior authorization for implantation of a neurostimulator to treat chronic pain.

Customizable template for obtaining prior authorization for implantation of a neurostimulator to treat chronic, intractable pain.

Resources

An analysis of the 5-year data from Kemler's trial of spinal cord stimulation for complex regional pain syndrome.

The referenced long-term clinical studies have shown that SCS provides statistically significant pain relief in patients with CRPS. Economic studies show that as compared to the conventional medical management of patients with CRPS, SCS should become cost-effective after about 2 years of its use.

This Literature Review was authored by Douglas E. Busby, MD. Dr. Busby, a former Medicare contractor medical director, is a Medtronic consultant.
Medtronic Inc., 2007

The long-term clinical studies that are summarized in this review have shown that SCS is effective in controlling pain associated with FBSS. The economic studies that are summarized in this review have indicated that as compared to conventional medical management of patients with FBSS, SCS should become cost-effective after about 2 years of its use.

This Literature Review was authored by Douglas E. Busby, MD. Dr. Busby, a former Medicare contractor medical director, is a Medtronic consultant.
Medtronic Inc., 2008

The National Institute for Health and Clinical Excellence (NICE) reviewed the available evidence for spinal cord stimulation for the treatment of chronic neuropathic pain as part of their health technology appraisal (HTA). All 403 patients included in the clinical studies assessed by NICE were implanted with Medtronic Neuromodulation SCS systems.

Long-term data from the PROCESS trial: Randomized controlled trial of spinal cord stimulation versus conventional medical management for failed back surgery syndrome.

A slide presentation summarizing the clinical and cost-effectiveness of spinal cord stimulation for complex regional pain syndrome.

A slide presentation summarizing the clinical and cost-effectiveness of spinal cord stimulation for failed back surgery syndrome.

Medtronic has compiled this information for your convenience. It is always the provider's responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Contact your local carrier/payer for interpretation of appropriate coverage and coding policies.

For unapproved uses, consult with your local carrier/payer before seeking reimbursement for use of a product that may be inconsistent with or not expressly specified in the FDA cleared or approved labeling (manual). Some payers may have policies that make it inappropriate to submit claims for such items or related services.