Medicare AdvantageCoverageMedium impact
MA05.064b, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Independence Blue Cross·Pain Management, PM&R (Physical Medicine & Rehab), Neurology +1 more·Medical Policy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria for Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) procedures. The billing team needs to review the new criteria to ensure proper documentation and coverage determination for these pain management procedures.
Action Required
By June 16, 2025: Billing team must access the full policy at the provided URL to review updated medical necessity criteria for PENS and PNT procedures. Update prior authorization checklists and provider documentation requirements based on the new criteria. Ensure all Medicare Advantage claims for these procedures meet the revised medical necessity standards to avoid denials.