Medicare AdvantagePrior AuthMedium impact
MA05.064b, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Independence Blue Cross·Pain Management, Neurology, PM&R (Physical Medicine & Rehab) +1 more·Medical Policy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Policy MA05.064b establishes updated medical necessity criteria for Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) effective immediately for Medicare Advantage plans. The billing team must review the specific medical necessity requirements and ensure prior authorization processes align with the new criteria to avoid claim denials.
Action Required
By 2025-06-16: Billing and clinical teams must obtain and review the full text of policy MA05.064b from the provided URL to identify specific medical necessity criteria for PENS and PNT procedures. Update prior authorization requirements in the billing system and ensure encounter forms include documentation fields for all new medical necessity criteria. Providers must be notified of updated documentation requirements. Contact the payer (IBX) if clarification is needed on specific CPT/HCPCS codes affected. Claims submitted without meeting the new medical necessity criteria will be denied.