Medicare AdvantageCoverageMedium impact
MA11.028l, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Independence Blue Cross·Urology, PM&R (Physical Medicine & Rehab), Neurology +1 more·Medical Policy
Effective date
Jan 21, 2026
We identified it
Jun 19, 2026
Summary
Policy MA11.028l regarding Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for incontinence control has been reissued effective 01/21/2026. This is a recent policy update (1 month old) that may contain revised coverage criteria, prior authorization requirements, or billing guidance for these neuromodulation procedures. The billing team must review the full policy text to identify specific changes from the previous version and implement any updated prior authorization, documentation, or coding requirements.
Action Required
By 01/21/2026 or immediately upon implementation: Billing team must obtain and review the complete MA11.028l policy text from the provided URL to identify specific prior authorization requirements, covered diagnoses, medical necessity criteria, and applicable CPT/HCPCS codes for SNS and PTNS procedures. Update billing system templates, prior authorization workflows, and provider communication materials to reflect any new requirements. Confirm whether prior authorization is required for SNS and PTNS procedures under Medicare Advantage plans. Train billing and authorization staff on any new documentation requirements or coverage restrictions before the effective date. Failure to implement required changes may result in claim denials or payment delays.