CPT 64567, in plain terms, covers Percutaneous electrical nerve field stimulation of cranial nerve branches without implantation, such as an ear-worn device. CPT 64567 is referenced in 13 tracked payer policy changes from CareSource, Excellus BlueCross BlueShield, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64567 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 64567 on AAPC
CareSource Georgia Medicaid is requiring prior authorization for 90+ new codes across multiple categories including durable medical equipment, hearing services, inpatient facility services, and outpatient diagnostics/services, effective August 1, 2026. Prior authorization will be mandatory for all nonparticipating providers and inpatient service requests.
New policy 1.01.58 with an effective date of May 21, 2026 classifies several cranial and auricular neuromodulation methods as investigational. The investigational methods are cranial electrical stimulation, external trigeminal nerve stimulation (Monarch), transcutaneous non-implantable vagus nerve stimulation (gammaCore Sapphire), transcutaneous supraorbital neurostimulation (Cefaly), and auricular electrostimulation, including percutaneous electrical nerve field stimulation (PENFS) such as P-Stim, IB-Stim and NSS-2 Bridge. The policy does not address cranial electrotherapy stimulation for the treatment of behavioral health conditions, or implantable vagus nerve stimulation and vagus nerve blocking therapy.
Under this notice, administrative changes are effective on the date of the notice, material changes are effective 90 days from the date of the notice, and new prior authorizations are effective 30 days from the date of the notice, unless otherwise specified. Effective May 1, 2026, the maximum frequency per day (MFD) policy requires allowable units up to the MFD on one claim line and any additional units on a separate claim line, and new reimbursement policies cover related services and supplies (RP-202603) and replacement codes for CMS status indicator I (RP-202604). Effective with dates of service on or after June 1, 2026, non-clinical disputes and corrected claims must be submitted within 180 days from the date of the original claim determination, and these timelines replace the previous requirements. CPT 43889 is added to the bariatric surgery policy and requires prior authorization effective June 1, 2026. The notice also revises a number of medical policies, including removing the frequency limitation and prior authorization requirement for certain bone mineral density codes.
Blue Cross NC updated multiple medical policies effective January 1, 2026, with extensive billing code changes including new CPT codes for IMRT procedures, archived spine-related policies, updated genetic testing codes, and new skin substitute codes. Most changes involve updating billing systems with new procedure codes while removing outdated ones.
Percutaneous electrical nerve field stimulation for abdominal pain in individuals with disorders of gut-brain interaction, including irritable bowel syndrome and functional dyspepsia, is considered investigational. The policy title changed from Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome to Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interaction, and the policy statement was updated to include disorders of gut-brain interaction and functional dyspepsia as investigational. This change is dated 09/28/2026 in the policy history.
With effective dates from January 1, 2026 through April 8, 2026. The update adds medical necessity and prior authorization review for electrophysiology studies, endovascular stent grafts for abdominal aortic aneurysms, shoulder arthrotomy, shoulder arthroscopy, abdominal wall hernia repair, and hip, knee and spine surgeries for Standard and Basic Federal Employee Program plans, and it expands site of service ASC review to upper GI endoscopy and shoulder procedures. It also changes many drug criteria, including preferred product and quantity limit updates, adds Carelon review for advanced imaging, and lists codes that became non-covered, investigational or terminated.
Percutaneous electrical neurostimulation, percutaneous neuromodulation therapy, and restorative neurostimulation therapy (ReActiv8) are each considered investigational. CPT code 1088T, for percutaneous application of high-frequency neuromodulation signals using a microneedle electrode array for nociceptive or neuropathic pain, was added with a date of 10/01/2026. Do not report 1088T in conjunction with CPT 64553, 64555, 97032, 97813, 97814, or 0278T.
New Virginia Medicaid policy establishes specific coverage criteria for neurostimulator procedures, with limited coverage for PENFS (age 8-20 only for IBS/functional abdominal pain) and exclusions for most cranial electrical stimulation and vagus nerve stimulation procedures.
Effective for dates of service on or after January 1, 2026, Indiana Medicaid lists the new CPT, CDT and other HCPCS codes from the 2026 annual HCPCS update as either covered or noncovered, and shows whether each one requires prior authorization or NDC. Codes discontinued in the update are listed with alternate code considerations, and the source states that inclusion of an alternate code does not indicate IHCP coverage of that alternate code. The IHCP is awaiting the final posting of the CMS fee schedules that set pricing for these codes, and reimbursement amounts will be posted on the Professional Fee Schedule and Outpatient Fee Schedule once pricing is established.
Blue Cross Blue Shield Association policy 2.01.106 was updated on 09/28/2026 to list percutaneous electrical nerve field stimulation for abdominal pain in disorders of gut-brain interaction, including irritable bowel syndrome and functional dyspepsia, as investigational. On the same date the policy title changed from the irritable bowel syndrome version to Disorders of Gut-Brain Interaction. Investigational means the treatment is not yet recognized as generally accepted standard practice and is therefore not considered medically necessary.
Aetna considers TENS units medically necessary durable medical equipment when used as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic, intractable pain not adequately responsive to other methods. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when all listed criteria are met. Percutaneous electrical nerve stimulation is considered medically necessary for chronic low back pain secondary to degenerative disc disease for up to a 30-day period within a multi-modality rehabilitation program, and for diabetic neuropathy or neuropathic pain that has not responded to listed medications. Many other electrical stimulation devices and indications are listed as experimental, investigational, or unproven.
Aetna considers TENS medically necessary durable medical equipment as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic intractable pain not adequately responsive to other methods such as physical therapy and pharmacotherapy. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when the member meets all listed criteria, including a successful percutaneous stimulation trial that resulted in at least a 50% reduction in pain for a minimum of 3 days. TENS for chronic low back pain, PENS for opioid withdrawal, and many other electrical stimulation devices and indications are considered experimental, investigational, or unproven.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan updated several medical policies in December 2025, mostly to add or delete CPT and Category III codes effective January 1, 2026. The coverage changes add criteria for leadless pacemakers (CAM 20232) and remove codes from the telehealth policy (CAM 176), and most other updates are annual reviews with no change in policy intent.
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