CommercialCoverageMedium impact
11.17.04y, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Independence Blue Cross·Urology, Neurology, Pain Management +1 more·Medical Policy
Effective date
May 28, 2025
We identified it
Jun 19, 2026
Summary
Policy 11.17.04y was reissued on 05/28/2025 addressing coverage criteria for Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) procedures for incontinence treatment. Billing teams must review the full policy text to identify any changes to prior authorization requirements, covered indications, billing codes, or documentation standards from the previous version.
Action Required
By 06/28/2025: Billing and clinical teams must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=05&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-11-17-04y to identify specific changes from the prior version. Update billing system rules, prior authorization workflows, and clinical documentation templates as needed for SNS and PTNS claims. Confirm whether prior authorization is required and document any new or changed coverage criteria. Notify providers treating incontinence patients that this policy has been reissued. Failure to comply with updated requirements may result in claim denials.