The trial period may be extended up to four weeks. Some patients may need an open procedure requiring laminectomy to place the electrodes.Īfter placement of the electrodes, the patient is provided with an external neurostimulator, initially on a trial basis. The neurostimulator electrodes used for this purpose are implanted percutaneously in the epidural space through a special needle. Spinal cord stimulation blocks pain conduction pathways to the brain and may stimulate endorphins. History/Background and/or General Information This section excludes routine physical examinations.Ĭoverage Indications, Limitations, and/or Medical NecessityĬompliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits. Title XVIII of the Social Security Act, Section 1862(a)(7).Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claims that lacks the necessary information to process the claim.Social Security Act (Title XVIII) Standard References: CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in LCDs.CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, Section 160.7 Electrical Nerve Stimulators. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site: Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Spinal Cord Stimulation (Dorsal Column Stimulation) and must properly submit only valid claims for them. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Spinal Cord Stimulation (Dorsal Column Stimulation). Not endorsed by the AHA or any of its affiliates. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2023 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2023 American Medical Association.
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