All PlansCoverageMedium impact
Sacral Nerve Neuromodulation/Stimulation
Blue Cross & Blue Shield of Mississippi·MS · Urology, OB-GYN, General Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a new medical policy establishing coverage criteria for sacral nerve neuromodulation/stimulation devices (InterStim, Axonics, Virtis systems) for treating urinary incontinence, fecal incontinence, and urinary retention. The policy requires documented failure of conservative treatments and a successful trial period showing 50% symptom improvement before permanent device implantation.
Action Required
Immediately: Billing team must review all sacral nerve neuromodulation claims to ensure documentation includes: 1) Specific diagnosis (urge incontinence, urgency-frequency, non-obstructive retention, overactive bladder, or chronic fecal incontinence), 2) Evidence of failed/intolerant conservative therapies, 3) Trial period results showing 50% symptom improvement, 4) Confirmation patient is appropriate surgical candidate. Update prior authorization requests to include these requirements. Claims without proper documentation may be denied.