CommercialCoverageMedium impact
Tibial Nerve Stimulation (7.01.106)
Blue Shield of California·CA · Urology·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jul 1, 2025
Summary
Blue Shield of California updated their tibial nerve stimulation policy effective July 1, 2025. Percutaneous tibial nerve stimulation (PTNS) is now covered for non-neurogenic overactive bladder patients who have failed both behavioral therapy (8-12 weeks) and pharmacologic therapy (4-8 weeks), with maintenance therapy covered monthly after successful initial treatment.
Action Required
By July 1, 2025: Billing team must update prior authorization requirements for tibial nerve stimulation procedures to verify patients have failed both behavioral therapy (8-12 weeks) and pharmacologic therapy (4-8 weeks) before approving PTNS for overactive bladder. Update documentation requirements to capture treatment failure history. Claims without proper documentation of failed therapies will likely be denied.