Levator Syndrome Treatments (CPB 0679, reviewed 2026-10-26)

Verify current applicability of this policy with Aetna. The source document was reviewed on 2026-10-26 but does not state a specific effective date for this policy bulletin. Billing team should: (1) Confirm whether this policy is currently in effect and applies to your patient population; (2) Update billing system denials logic to reject claims for pudendal nerve injections (CPT 64430, 64630), sacral nerve stimulation (CPT 64561, 64575), and home electro-galvanic stimulators as non-covered (experimental/investigational); (3) Implement prior authorization requirements or medical necessity documentation collection for CPT 97014 and 97032 (electrical stimulation) and HCPCS E0746 (biofeedback device) when billed for levator syndrome (ICD-10 K62.89), ensuring documentation confirms failure of conservative treatments and absence of underlying disease; (4) Train billing and clinical staff that coverage for high-voltage pulsed electro-galvanic stimulation is limited to no more than three 60-minute sessions administered over a 10-day period; (5) Reject or request prior authorization for claims exceeding this session/timeframe limitation.