MedicaidCoverageMedium impact
Neurostimulators - MEDICAID - VIRGINIA (New)
Humana·VA · Neurosurgery, Pain Management, Gastroenterology +2 more·Medicaid
Effective date
Jun 17, 2026
We identified it
Jun 24, 2026
Summary
New Virginia Medicaid policy establishes specific coverage criteria for neurostimulator procedures, with limited coverage for PENFS (age 8-20 only for IBS/functional abdominal pain) and exclusions for most cranial electrical stimulation and vagus nerve stimulation procedures.
Action Required
Before June 17, 2026: Billing team must update Virginia Medicaid billing rules to restrict PENFS (64567) to ages 8-20 for IBS/functional abdominal pain only, and flag cranial electrical stimulation (E0732) and vagus nerve stimulation procedures (0908T, 0909T, 0911T, 0912T) as non-covered. Update prior authorization system to verify age requirements for PENFS. Claims outside these criteria will be denied.