CommercialCoverageMedium impact
Sacral Nerve Stimulation 7.01.10
Excellus BlueCross BlueShield·Urology, Gastroenterology, General Surgery·Nervous Systems (Neurology)
Effective date
Mar 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their sacral nerve stimulation policy effective March 16, 2026, establishing specific coverage criteria for urinary conditions and fecal incontinence in patients ≥16 years old. The policy requires trial stimulation success (≥50% improvement) before permanent placement approval and excludes coverage for neurological conditions, stress incontinence, and bilateral stimulation.
Action Required
By March 16, 2026: Billing team must update prior authorization protocols for sacral nerve stimulation procedures to verify patient age (≥16 years), document trial stimulation results showing ≥50% improvement, confirm failure of conservative treatments, and ensure conditions are not excluded (stress incontinence, neurological causes, bilateral stimulation). Update encounter forms to include required documentation checklist for urinary retention, urgency-frequency syndrome, and fecal incontinence cases.