Percutaneous Electrical Nerve Stimulation (PENS), Percutaneous Neuromodulation Therapy, Restorative Neurostimulation Therapy, and Percutaneous Electrical Nerve Field Stimulation (PENFS)
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This policy governs coverage determinations for percutaneous electrical nerve stimulation (PENS), percutaneous neuromodulation therapy (PNT), restorative neurostimulation (ReActiv8), and percutaneous electrical nerve field stimulation (PENFS) for Blue Cross Blue Shield of North Carolina members and providers.
Policy title expanded to include Restorative Neurostimulation Therapy and updated statement that Restorative neurostimulation therapy (ReActiv8) is considered investigational for all applications.
Updated Billing/Coding to remove 0720T and add 64567 effective 1/1/2026.
PENFS, including IB-stim, is considered investigational.
Coverage Determinations
Not covered (Investigational)
Coverage determination
BCBSNC does not provide coverage for investigational services or procedures.
Not covered — investigational therapies
Policy coverage stance and investigational determinations
BCBSNC does not provide coverage for investigational services or procedures.
When Percutaneous Electrical Nerve Stimulation (PENS), Percutaneous Neuromodulation Therapy (PNT), Restorative Neurostimulation Therapy (ReActiv8), and Percutaneous Electrical Nerve Field Stimulation (PENFS) are covered: Not applicable. The policy lists these modalities — PENS/PNT, PENFS (including IB‑Stim), and ReActiv8 — as investigational for all applications and does not provide coverage for investigational services or procedures.
Restorative neurostimulation therapy (ReActiv8) is considered investigational for all applications. BCBSNC does not provide coverage for investigational services or procedures. This statement was reiterated in the policy and retained following the most recent Medical Director review and policy title expansion.
Percutaneous electrical nerve field stimulation (PENFS), including IB‑Stim, is considered investigational for all applications. BCBSNC does not provide coverage for investigational services or procedures. The policy implementation notes also document updates to descriptions and regulatory information regarding PENFS devices.
Summary: PENS/PNT, PENFS (including IB‑Stim), and ReActiv8 are all considered investigational for all indications in this policy and are therefore not medically necessary under BCBSNC criteria. Claims for these services will be denied as investigational.
Services determined to be investigational — specifically ReActiv8 and PENFS/IB‑Stim — are not provided coverage by Blue Cross Blue Shield of North Carolina. The policy implementation and billing/coding updates reiterate that the investigational determinations remain unchanged.
Billing and Coding
| 0720T | Previously added to Billing/Coding, later removed |
| 64567 | Added to Billing/Coding effective 1/1/2026 |
| 64555 | Added to Billing/Coding (6/10/26 update) |
| 64585 | Added to Billing/Coding (6/10/26 update) |
| 64596 | Added to Billing/Coding (6/10/26 update) |
| 64597 | Added to Billing/Coding (6/10/26 update) |
| 95970 | Added to Billing/Coding (6/10/26 update) |
| 95971 | Added to Billing/Coding (6/10/26 update) |
| 95972 | Added to Billing/Coding (6/10/26 update) |
| C1767 | Added to Billing/Coding (6/10/26 update) |
Provider Responsibilities and Documentation
List of applicable codes — prior review may be required
Applicable service codes are listed in the Billing/Coding section; inclusion of a code does not guarantee reimbursement. BCBSNC may require submission of medical records for medical necessity review when evaluating claims for these codes.
Medical records may be requested for medical necessity review
BCBSNC may request medical records to determine medical necessity prior to coverage decisions; providers should be prepared to submit complete records when asked.
Conservative therapy context — TENS trial usual prerequisite
PENS is generally reserved for patients who fail to obtain pain relief from TENS; this is described as the usual clinical context before considering PENS.
Historical note — prior TENS failure referenced in older policy
Older iterations of the policy referenced failure of TENS as part of eligibility for PENS; the current document notes this historical context but classifies the therapies as investigational.
Medical record requests — letters alone often insufficient
When medical records are requested, BCBSNC often finds letters of support or explanation useful but letters alone are not sufficient unless they include all specific information needed to make a medical necessity determination.
- Provide complete medical records when requested; supporting letters must contain all required clinical detail to be sufficient
Provide complete records and supporting documentation when requested
If BCBSNC requests medical records, include all specific clinical information needed to determine medical necessity; incomplete documentation may not satisfy review requirements.
- Include objective clinical findings and prior treatment history when relevant
- Ensure supporting letters contain the same detailed information as chart documentation if submitted in place of records
Denial risk — PENS/PNT/PENFS/ReActiv8 considered investigational
Claims for PENS, PNT, PENFS (including IB‑Stim), and ReActiv8 will be denied as investigational; BCBSNC does not provide coverage for these investigational services or procedures.
- Do not expect coverage for these therapies; submit only when supported by an applicable exception or updated policy
Denial risk if requested records are not provided
BCBSNC may request medical records for determination of medical necessity, and absence of requested documentation may result in denial of the claim or prior authorization request.
Definitions and Device Descriptions
Prior Conservative Therapy Context
Failure of prior TENS trial is described as the usual context before considering PENS
Context for conservative therapy prior to consideration of PENS
This is contextual background; the policy currently classifies PENS/PNT as investigational and not covered.
Failure of prior conservative therapy historically considered, but current policy classifies therapies as investigational
Historical policy context
Historical references remain for context but do not change the current investigational determination.
Imaging and Assessment Requirements
Imaging requirements — none specified
The current policy does not specify any imaging requirements for PENS, PNT, PENFS, or ReActiv8; no imaging studies are mandated in this document.
- Billing/Coding/Physician Documentation section does not list imaging prerequisites
Historical imaging/assessment references — current document silent on imaging
Older policy iterations referenced clinical assessment elements (for example, prior conservative therapy or clinical evaluation), but the current partial document does not specify imaging requirements for these therapies.
- Historical policy updates discuss clinical assessment elements without defining imaging prerequisites
Background and Scope
Background: Neuromodulation approaches evaluated in this policy include percutaneous electrical nerve stimulation (PENS), percutaneous neuromodulation therapy (PNT), percutaneous electrical nerve field stimulation (PENFS, including IB‑Stim), and restorative neurostimulation (ReActiv8). These modalities have been assessed for chronic musculoskeletal, neuropathic, and functional pain conditions (for example, low back pain, neuropathic pain, chronic headache, and functional abdominal pain/IBS). The policy concludes these therapies are investigational for all applications and therefore not covered.
Not Covered / Exclusions
NOT COVERED: The following are not covered for any application: Percutaneous electrical nerve stimulation (PENS); Percutaneous neuromodulation therapy (PNT); Percutaneous electrical nerve field stimulation (PENFS), including IB‑Stim; and Restorative neurostimulation therapy (ReActiv8). BCBSNC does not provide coverage for investigational services or procedures as stated in the policy.
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