Medicare AdvantageCoverageMedium impact
Percutaneous electrical nerve stimulation and percutaneous neuromodulation therapy
Blue Cross Blue Shield of Rhode Island·RI · Pain Management, Neurology, PM&R (Physical Medicine & Rehab) +1 more·Physician / Facility
Effective date
Oct 2, 2018
We identified it
Jun 20, 2026
Summary
Effective October 2, 2018, percutaneous electrical neurostimulation (PENS) and percutaneous neuromodulation therapy (PNT) are now considered medically necessary for chronic pain treatment when pain is effectively controlled by percutaneous stimulation and electrode implantation is warranted. However, Commercial products continue to consider this service not medically necessary.
Action Required
Billing team must verify plan type before billing PENS/PNT procedures for chronic pain. For non-Commercial plans (Medicare, Medicaid), ensure documentation shows pain is effectively controlled by percutaneous stimulation and electrode implantation is warranted. Continue to treat as not medically necessary for Commercial plans to avoid denials.