Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Urology, Gastroenterology, Pain ManagementMedium impact

Sacral Nerve Neuromodulation Stimulation

Effective date
Not stated in the notice
Identified
Oct 17, 2026

Summary

Policy A.7.01.69 states that sacral nerve neuromodulation may be considered medically necessary as a trial for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met, and as a trial for chronic fecal incontinence when its separate criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period shows at least 50% improvement in symptoms over at least 48 hours, while chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition are investigational. The policy was updated on 09/17/2026 to change the device description, renumber the urinary incontinence Criteria A statements, and remove ICD-9 procedure and diagnosis codes from the code reference section.

Get alerts when payers change rules like this one

We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.

What to do

Action · 8 steps
01Urinary trial criteria: the diagnosis is urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder; there is documented failure or intolerance to at least two conventional conservative therapies, such as behavioral training, prompted voiding, pelvic muscle exercise training, pharmacologic treatment, and/or surgical corrective therapy; the individual is an appropriate surgical candidate; and the incontinence is not related to a neurologic condition.
02Permanent urinary implantation requires all of those criteria plus a trial stimulation period showing at least 50% improvement in symptoms over at least 48 hours.
03Fecal incontinence trial criteria: more than 2 incontinent episodes on average per week for more than 6 months, or for more than 12 months after vaginal childbirth; documented failure or intolerance to conventional conservative therapy for a sufficient duration; an appropriate surgical candidate; the condition is not related to an anorectal malformation or chronic inflammatory bowel disease; the incontinence is not related to a neurologic condition; and no rectal surgery in the previous 12 months, or in the past 24 months for cancer.
04Permanent fecal implantation requires all of those criteria plus at least 50% improvement in symptoms over at least 48 hours in a trial.
05The listed codes are ONLY medically necessary if the procedure is performed according to the Policy section.
06Document that the criteria are met, because BCBSMS makes no payment for services not documented to be medically necessary.
07Chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition are investigational under this policy.
08For Federal Employee Program members, FDA-approved devices may not be considered investigational and may be assessed only on the basis of medical necessity.

Codes mentioned

6456164555645756458164590645966459795970959719597295973645856459564598A4290E0745E1399L8680L8681L8682L8683L8684L8685L8686L8687L8688R15.9R15.2R33.0R33.8R33.9R39.14N39.41R35.0

Original notice

Sacral Nerve Neuromodulation Stimulation
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Sacral Nerve Neuromodulation/StimulationMediumNo effective date · Medical PolicyDeep Brain StimulationMediumNo effective date · Medical PolicyImplantable Peripheral Nerve Stimulation for Chronic Pain ConditionsMediumNo effective date · Medical PolicyVagus Nerve StimulationMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesUrologyGastroenterologyPain ManagementCode 64561Code 64555Code 64575Code 64581Code 64590Code 64596Code 64597Code 95970Code 95971Code 95972Code 95973Code 64585Code 64595Code 64598Code A4290Code E0745Code E1399Code L8680Code L8681Code L8682Code L8683Code L8684Code L8685Code L8686Code L8687Code L8688Code R15.9Code R15.2Code R33.0Code R33.8Code R33.9Code R39.14Code N39.41Code R35.0

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account