CPT 64585, in plain terms, covers Surgeon revises or removes the electrode array of an implanted peripheral nerve stimulator. CPT 64585 is referenced in 17 tracked payer policy changes from Blue Cross NC, Excellus BlueCross BlueShield, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64585 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 64585 on AAPC
Blue Cross NC updated 29 medical policies with various changes including coverage expansions for proton beam therapy, new billing codes for nerve stimulation procedures, and formatting updates. Most changes are administrative updates to references and policy guidelines without changing coverage decisions.
Excellus BlueCross BlueShield medical policy 1.01.60, Implantable and Invasive Neuromodulation Systems, is a new policy with an effective date of May 21, 2026, and its content was derived from policy 1.01.55, Electrical Stimulation as a Treatment for Pain and Other Medical Conditions. Permanent peripheral nerve stimulation (PNS) systems, temporary PNS systems such as SPRINT, restorative neurostimulation such as ReActiv8, and percutaneous electrical nerve stimulation or percutaneous neuromodulation therapy (PENS/PNT) are all investigational under this policy. The policy does not address sacral, spinal cord/dorsal column stimulation or tibial nerve stimulation.
Excellus BlueCross BlueShield policy 7.01.10, Sacral Nerve Stimulation, has a current effective date of March 16, 2026. The November 20, 2025 off-cycle review clarified the sacral nerve stimulation trial and permanent placement criteria. Sacral nerve stimulation is medically appropriate for individuals 16 and older who meet both the trial stimulation and permanent placement criteria, and it is considered investigational for stress incontinence, urge incontinence due to a neurological condition, other chronic voiding dysfunction, constipation, chronic pelvic pain and bilateral sacral nerve stimulation.
Independence Blue Cross reissued Policy 11.17.04z to add two new CPT codes (0988T and 0989T) as experimental/investigational effective 01/01/2026. These codes are excluded from coverage for all Independence Blue Cross products and are not eligible for reimbursement. The policy also reaffirms existing coverage criteria for sacral nerve stimulation (SNS) and posterior tibial nerve stimulation (PTNS) for incontinence treatment.
Aetna considers cannabinoids, hypnotherapy, hypogastric plexus neurolysis for chronic pelvic pain associated with endometriosis, neuromodulation (dorsal root ganglion stimulation, posterior tibial nerve stimulation, sacral nerve stimulation, and spinal cord stimulation), peritoneal excision (stripping) for endometriosis, and superior hypogastric plexus block with traditional pharmacological treatments experimental, investigational, or unproven. Uterine nerve ablation, laparoscopic uterine nerve ablation and presacral neurectomy are also considered experimental, investigational, or unproven for chronic pelvic pain or other indications. The policy lists related CPT and HCPCS codes, and endometriosis ICD-10 codes, as not covered for the indications it names.
Policy A.7.01.69 states that sacral nerve neuromodulation may be considered medically necessary as a trial for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met, and as a trial for chronic fecal incontinence when its separate criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period shows at least 50% improvement in symptoms over at least 48 hours, while chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition are investigational. The policy was updated on 09/17/2026 to change the device description, renumber the urinary incontinence Criteria A statements, and remove ICD-9 procedure and diagnosis codes from the code reference section.
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 Clinical Policy Bulletin 0223 on urinary incontinence, reviewed 2026-07-16, considers multi-channel urodynamic studies medically necessary when a member has both symptoms and physical findings of urinary incontinence or voiding dysfunction and the provider is considering invasive, potentially morbid or irreversible treatment after conservative management has failed. It considers medically necessary the artificial urinary sphincter, FDA-cleared peri-urethral bulking agents, permanent sacral nerve stimulators after temporary trial stimulation, percutaneous tibial nerve stimulation, weighted vaginal cones, pessaries, tension-free and transobturator tape procedures, colposuspension and sub-urethral sling procedures when the stated criteria are met. Bilateral permanent sacral nerve stimulator implantation, the Genityte and FemiLift laser procedures, stem cell therapy and many other listed interventions are considered experimental, investigational or unproven.
Aetna's Clinical Policy Bulletin 0852 on neurogenic bladder, last reviewed 12/23/2025, considers enterocystoplasty (augmentation cystoplasty) or urinary diversion surgery medically necessary when conservative treatments, including anticholinergic medications and urinary catheters, have failed or are contraindicated. The policy considers a long list of other treatments experimental, investigational or unproven for neurogenic bladder, including acupuncture, beta-agonists such as mirabegron, biofeedback, peripheral neuromodulation (pudendal, sacral and tibial nerve stimulation), TENS, transcranial magnetic stimulation, transurethral electrical stimulation, and intravesical gentamicin or neomycin-polymyxin. CPT codes 51960 (enterocystoplasty) and 50825 (continent diversion) are covered if selection criteria are met.
Cannabinoids, hypnotherapy, hypogastric plexus neurolysis for chronic pelvic pain associated with endometriosis, neuromodulation (dorsal root ganglion stimulation, posterior tibial nerve stimulation, sacral nerve stimulation, and spinal cord stimulation), peritoneal excision (stripping) for endometriosis, superior hypogastric plexus block with traditional pharmacological treatments, and uterine nerve ablation, laparoscopic uterine nerve ablation and presacral neurectomy for chronic pelvic pain or other indications are considered experimental, investigational, or unproven because their effectiveness has not been established. The policy lists CPT codes not covered for the indications it lists, including neurostimulator implantation, revision, removal and programming codes, superior hypogastric plexus injection code 64517, and hypnotherapy code 90880, along with ICD-10 diagnosis codes not covered for those indications. Peritoneal excision (stripping) has no specific code in this policy.
Aetna considers the diagnosis and treatment of erectile dysfunction medically necessary under the criteria in its policy, including self-administered injectable medications, the external penile vacuum pump as a physician-prescribed durable medical equipment alternative to other therapies, and implantable penile prostheses when the documented criteria are met. Surgical correction of Peyronie's disease, such as plaque excisions, venous graft patching, tunica plication or the Nesbit tuck, is medically necessary for members who have the condition for 12 or more months with significant morbidity and have failed conservative medical treatment. Many other treatments, including extracorporeal shock wave therapy and testosterone injection for Peyronie's disease and stem cell therapy for erectile dysfunction, are considered 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.
A trial of sacral nerve neuromodulation, using percutaneous nerve stimulation or a temporarily implanted lead, may be considered medically necessary for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period demonstrates at least 50% improvement in symptoms over at least 48 hours. For chronic fecal incontinence, a trial may be considered for more than 2 incontinent episodes on average per week for more than 6 months, or more than 12 months after vaginal childbirth, after documented failure of conventional conservative therapy. Sacral nerve neuromodulation is considered investigational for chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition. The 09/17/2026 update revised device descriptions, re-numbered the Criteria A statements for urinary incontinence, and removed ICD-9 procedure and diagnosis codes from the code reference.
Peripheral nerve stimulation as a treatment for chronic pain is considered investigational under this policy. Peripheral nerve stimulation is a percutaneous system of leads, electrodes, and a pulse transmitter that delivers electrical impulses to peripheral nerves, and a number of these devices have been cleared by the FDA through the 510(k) process. Spinal cord and dorsal root ganglion stimulation are covered in a separate medical policy and are not reviewed in this policy.
Effective June 18, 2018, the select surgical procedures policy (11.01.524) now requires review for investigative status and prior authorization, and the implantable neurostimulator codes (L8679 through L8688) no longer require site of service review but are reviewed for medical necessity and require prior authorization. Effective July 1, 2018, knee osteochondral allograft arthroscopy (29867), endoscopic lumbar decompression (62380), cervical artificial disc (0375T), Hemlibra (Q9995), epoetin alfa biosimilar Retacrit (Q5105, Q5106) and several genetic and molecular tests (0045U, 0060U, 0047U, 0053U, 0048U, 0050U, 0057U, 0030U, 0032U, 0033U) and lung proteomic testing (81538) moved to prior authorization or investigational review as stated in the notice. Effective July 1, 2018, J8565 and J8999 (oral EGFR inhibitor codes) and sacral neuromodulation codes 64585 and 64590 no longer require medical necessity review or prior authorization. Effective July 5, 2018, transesophageal endoscopic GERD therapy codes 43201, 43236 and 43257 are investigational and no longer require medical necessity review or prior authorization.
This WA and Alaska medical policy and coding update lists changes with effective dates from November 1, 2019 through February 9, 2020. Implantable peripheral nerve stimulation for the treatment of chronic pain of peripheral nerve origin is considered investigational, and irreversible electroporation (NanoKnife System) is considered investigational for all indications. Coding updates effective November 1, 2019 list codes 64555, 64575, 64585, 64590 and 64595 as now requiring review for investigational status, and coding updates effective February 9, 2020 list code 55874 as now requiring review for medical necessity and prior authorization.
Independence Blue Cross reissued MA11.028l on 01/21/2026 to communicate the company's continuing position on Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for incontinence control. Two new experimental/investigational CPT codes (0988T and 0989T) were added effective 01/01/2026 and are NOT covered. No changes to existing coverage criteria or medically necessary procedures.
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