All PlansCoverageMedium impact
Spinal Cord and Dorsal Root Ganglion Stimulation
Regence BlueShield·Pain Management, Neurosurgery, Orthopedics +2 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
New medical policy establishes coverage criteria for spinal cord stimulation and dorsal root ganglion stimulation devices for chronic pain conditions including failed back surgery syndrome, complex regional pain syndrome, chronic critical limb ischemia, and chronic stable angina. Policy requires 6 months of conservative therapy failure, psychological evaluation, and 50% pain reduction during trial before permanent implantation.
Action Required
Before July 1, 2026: Billing team must implement prior authorization requirements for spinal cord stimulation and dorsal root ganglion stimulation procedures. Update system to verify 6 months of documented conservative therapy failure, psychological evaluation attestation, and 50% pain reduction during trial period before permanent implant authorization. Train staff on specific diagnostic criteria for each covered condition (failed back surgery syndrome, complex regional pain syndrome, chronic critical limb ischemia, chronic stable angina).