Spinal Cord Stimulators

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Overview Required Clinical Documentation How to Submit
What is a spinal cord stimulator?

An implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Spinal cord stimulators require two procedures:

    1. The Trial AND
    2. The Permanent Implantation

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Additional Information:

  • Spinal cord stimulators should be reserved as a last resort for pain management.
  • These requests should almost always be done in an outpatient setting:
    • Exception: If there is an additional request associated with the stimulator request that meets inpatient criteria.
  • Dorsal Root Ganglion Stimulation (DRG) requests do not meet Humana Medicare criteria and will pend or be denied.

Terms to know:

  • Pulse generator: small, pacemaker-like battery pack. Also called batteries, generators, IPG (internal pulse generator)
  • Lead: placed above the spinal cord
  • Extension wire: connects the lead to the generator 

Procedure Types:

Trial

1st phase

Under sedation, the patient received a lead/ electrode inserted to the vertebral level desired. If 50% or greater pain relief and improved functionality is achieved, it is considered a successful trial and moves onto the permanent implantation phase.

Permanent Implantation

2nd phase

Patient is kept awake during this procedure to ensure proper placement of a longer term stimulator.
Revision A provider may need to perform a revision for: inadequate coverage of their pain, or a need to revise the area of implantation.
Replacement May occur for replacement of the battery of the stimulator.
Removal May occur for things such as: the patient presenting with signs and symptoms of infection at implantation site, or if the patient needs to have an MRI performed.

 

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