ModifiedUnitedHealthcarePolicy CS358ID.B

Sacral Nerve Stimulation for Urinary and Fecal Indications (for Idaho Only)

Medical policy governing sacral nerve stimulation (SNS/SNM) screening trials, permanent implantation, replacements/revisions, and indications for adults in the state of Idaho (including Idaho Medicaid Plus).

Policy Summary

PayerUnitedHealthcare

PolicySacral Nerve Stimulation for Urinary and Fecal Indications (for Idaho Only)

Policy CodePolicy CS358ID.B

Change TypeContent updates and additions (definitions, documentation, ICD-10 codes)

Effective DateMay 1, 2026

Next Review Date

Key ActionObtain prior authorization and include documentation of conservative therapy failure and a ≥50% symptom improvement during a test stimulation before requesting permanent implantation.

SourceLink

POLICY UPDATE CHANGES

Replaced references to 'Sacral Nerve Stimulation' with 'Sacral Nerve Stimulation (neurostimulation)'.

Added language specifying that medical records documentation may be required to assess whether the member meets clinical criteria and listing items that must be documented.

Added definition of Fowler's Syndrome and updated definition of 'Urge Incontinence'.

Added ICD-10 diagnosis codes R35.81, R39.191, and R39.192 to Applicable Codes for urinary indications.

Updated Clinical Evidence, FDA, and References sections to reflect current information.

≥18age applicability

50%screening trial threshold

≥300 mLchronic retention PVR

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Coverage Criteria for Sacral Nerve Stimulation

Screening trial for urinary voiding dysfunction

Screening trial is medically necessary when ALL of the following are met:

Urinary indications: Lower urinary tract symptoms: overactive bladder symptoms (urgency-frequency), urge incontinence, or nonobstructive urinary retention (NOUR)

Bladder capacity of 100 mL or greater>=100 mL

Not neurologic: Urinary voiding dysfunction is not secondary to a neurologic disease origin (e.g., Parkinson's disease, stroke, spinal cord injury, multiple sclerosis)

No obstruction: No bladder outlet or mechanical obstruction (e.g., BPH, tumor/radiation obstruction, urethral stricture)

Refractory to conservative care: Symptoms refractory to conservative care (e.g., bladder training, pelvic floor rehabilitation, pharmacologic therapy)

Operability: Individual capable of operating sacral nerve stimulating device

Permanent implantation for urinary voiding dysfunction

Permanent implantation is medically necessary when ALL of the following are met:

Prior trial: All criteria for Sacral Nerve Stimulation (screening trial) for urinary voiding dysfunction have been met

Trial response: Improvement in reported symptoms of 50% or greater in response to a screening trial of Sacral Nerve Stimulation>=50%

Test-phase defined by PNE or Stage 1 duration per policy

Screening trial for fecal incontinence

Screening trial is medically necessary for fecal incontinence when ALL of the following are met:

Refractory to conservative care: Symptoms refractory to conservative care (e.g., bowel training, bulking agents, pelvic floor rehabilitation, pharmacologic therapy)

Operability: Individual capable of operating sacral nerve stimulating device

Not neurologic: Fecal incontinence is not secondary to a neurologic disease origin (e.g., Parkinson's disease, stroke, spinal cord injury, multiple sclerosis)

Not secondary to constipation: Fecal incontinence is not secondary to constipation

Permanent implantation for fecal incontinence

Permanent implantation is medically necessary when ALL of the following are met:

Prior trial: All criteria for Sacral Nerve Stimulation screening trial for fecal incontinence have been met

Trial response: Improvement in reported symptoms of 50% or greater in response to a screening trial of Sacral Nerve Stimulation>=50%

PNE typically 10–21 days for bowel indications

Replacement or revision

Device nonfunctional: Existing sacral nerve stimulation device is nonfunctional and either cannot be repaired or is no longer under warranty

Individual must have met original indication criteria

Not medically necessary / Unproven indications

Unproven indications: Sacral nerve stimulation for the treatment of constipation and chronic pelvic pain is considered unproven and not medically necessary due to insufficient evidence of safety and/or efficacy

Includes refractory idiopathic slow transit constipation and general CPP indications lacking high-quality evidence

Coverage criteria for consideration of SNM and neuromodulation

Evidence-supported coverage considerations when SNM or related neuromodulation is used:

Refractory indication and prior therapy: Patient has refractory overactive bladder or lower urinary tract dysfunction after failure of behavioral and pharmacologic therapies

SNM and PTNS described as third-line options in health technology assessments

Test-phase response required: Staged test stimulation demonstrating ≥50% symptom improvement during the test phase before permanent implant≥50% improvement

Defined in RCTs and systematic reviews (Elterman et al., van Ophoven et al.)

Appropriate indications: SNM may be considered for OAB, urinary urge incontinence, non-neurogenic lower urinary tract dysfunction, select neurogenic indications (nDO, neurogenic NOUR), fecal incontinence including LARS, and some chronic pelvic pain syndromes when other therapies have failed

Success rates and evidence strength vary by indication

Indications and evidence-based coverage stance

Coverage stance and guideline-backed indications derived from specialty society guidance in the provided text.

OAB/UUI (non-neurogenic): Offer SNM to patients with OAB/UUI refractory to behavioral and pharmacologic therapy or intolerant of medical therapy; appropriate for carefully selected patients willing to undergo surgical procedure; considered a third-line therapy.refractory to conservative/pharmacologic therapy

Guideline support: AUA/SUFU 2023, EAU, ICS

Fecal incontinence (FI): Consider SNM for individuals with moderate or severe FI who have not responded to a three-month or longer trial of conservative measures and biofeedback and have no contraindications.failure of conservative therapy >= 3 months

Guideline support: ACG, AGA

Chronic pelvic pain (CPP) and Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS): Evidence limited; SNM may help some individuals with CPP and IC/BPS but benefits are greater for non-BPS/IC etiologies; high-quality randomized evidence lacking and outcomes variable.

Indications supported by guidelines

Covered when guideline-recommended conditions are met:

Refractory OAB/UUI: Offer SNM to individuals with overactive bladder/urge urinary incontinence refractory to anticholinergic or conservative therapy or when conservative treatment and medications have not worked; may be considered after botulinum toxin failure or when patient declines botulinum toxin owing to catheterization risk.

EAU strong recommendation; NICE supports adoption for refractory OAB

Non-obstructive urinary retention (NOUR): SNM is an option for idiopathic chronic non-obstructive urinary retention when conservative treatments have failed, per NICE guidance and ICS statements.

NICE interventional guidance supports use with clinical governance and specialist units

Fecal incontinence (FI): SNM should be considered for bothersome fecal incontinence after failure of conservative measures; ASCRS and ICS endorse as second-line or possible first-line surgical option depending on guidelines.

Axonics r-SNM has FDA PMA for chronic fecal incontinence

Test-phase success and contraindications

Test-phase and contraindication logic:

Test response required: Patient achieves >=50% improvement in one or more target symptoms during PNE or Stage 1 test period to be offered complete system implantation.>=50% improvement

PNE typically 7 days for bladder, 10-21 days for bowel; Stage 1 typically 2-3 weeks

Absolute contraindications: Do not proceed with SNM if there is insufficient clinical response to a therapeutic trial, patient is incapable of operating the device without supportive caregivers, or if the patient is pregnant.

Listed as absolute contraindications by ICS

Coverage excludes individuals whose urinary or fecal dysfunction is clearly secondary to another condition. Specifically, SNM is not indicated when dysfunction is caused by neurologic disease (for example, Parkinson’s disease, stroke, spinal cord injury, or multiple sclerosis), by mechanical bladder outlet obstruction (such as BPH, tumor or radiation–related obstruction, or urethral stricture), by distorted anorectal anatomy (for example anorectal malformation, abscess/fistula, or prior rectal surgery), or when fecal incontinence is secondary to constipation.

The evidence base for SNM in chronic pelvic pain (CPP) is insufficient to support routine coverage. Systematic reviews and a small number of randomized trials report heterogeneous results and low-quality data; additional high-quality, controlled studies are required before SNM can be considered a proven therapy for broad CPP indications.

Use of SNM for constipation (including refractory idiopathic slow‑transit constipation and functional constipation) is not supported by robust, consistent evidence. Systematic reviews and randomized trials show conflicting or negative results and uncertain long‑term effectiveness and cost‑effectiveness; therefore routine coverage for constipation is not supported.

Providers should recognize listed relative contraindications when evaluating candidates for SNM. These include severe or rapidly progressive neurologic disease, established complete spinal cord injury, a known anticipated need for MRI of body parts below the head, and abnormal sacral anatomy. Presence of these conditions may render a patient an unsuitable candidate or require individualized assessment.

Before applying this policy to a coverage decision, confirm the member’s entitlement under the controlling federal, state, or contractual benefit plan requirements; those requirements govern if they differ from this policy.

Sacral nerve stimulation for the treatment of constipation and chronic pelvic pain is considered unproven and not medically necessary given the current evidence base; these indications lack sufficient data on efficacy and safety to support routine permanent implantation.

For chronic pelvic pain specifically, the literature is limited and heterogeneous; SNM may help select functional bladder‑related pain syndromes, but high‑quality randomized evidence is lacking and benefit for general CPP populations remains uncertain.

Randomized trial data do not support routine permanent implantation for refractory constipation. A placebo‑controlled cross‑over trial failed to show a significant benefit of active stimulation over sham, and systematic reviews report inconsistent findings, so permanent implantation for constipation is not supported by high‑quality randomized evidence.

Patients with conditions listed as relative contraindications (for example complete spinal cord injury or anticipated need for MRI below the head) may be unsuitable candidates for SNM; such findings should prompt careful evaluation and documentation before proceeding with trial or implantation.

Applicable Codes and Coding Notes

Applicable CPT/Local codesCPT

0784T	Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed.
0785T	Revision or removal of neurostimulator electrode array, spinal, with integrated neurostimulator.
0786T	Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed.
0787T	Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator.
64561	Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed.
64581	Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement).
64585	Revision or removal of peripheral neurostimulator electrode array.
64590	Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver.
64595	Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array.

Applicable HCPCS/Device codesHCPCS

L8679	Implantable neurostimulator, pulse generator, any type.
L8680	Implantable neurostimulator electrode, each.
L8682	Implantable neurostimulator radiofrequency receiver.
L8685	Implantable neurostimulator pulse generator, single array, rechargeable, includes extension.
L8686	Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension.
L8687	Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension.
L8688	Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension.

Applicable ICD-10 diagnosis codes (urinary and fecal indications)ICD-10

N32.81	Overactive bladder.
N32.9	Bladder disorder, unspecified.
N39.3	Stress incontinence (female) (male).
N39.41	Urge incontinence.
N39.42	Incontinence without sensory awareness.
N39.46	Mixed incontinence.
N39.490	Overflow incontinence.
N39.498	Other specified urinary incontinence.
R32	Unspecified urinary incontinence.
R33.0	Drug induced retention of urine.

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Applicable ICD-10 Diagnosis Codes (urinary indications) — addedICD-10

R35.81	Added ICD-10 diagnosis code (urinary indication) as listed in policy Applicable Codes
R39.191	Added ICD-10 diagnosis code (urinary indication) as listed in policy Applicable Codes
R39.192	Added ICD-10 diagnosis code (urinary indication) as listed in policy Applicable Codes

inv-24: Screening trial response — ≥ 50% improvement in reported symptoms (key value)

Screening trial response≥ 50% improvement in reported symptoms during the screening trial

Use for permanent implantationImprovement of 50% or greater during screening trial is required before permanent implant

DocumentationBaseline and test-phase voiding diaries or patient‑reported outcomes commonly used to demonstrate ≥50% improvement

inv-25: Minimum bladder capacity — ≥ 100 mL (key value)

Minimum bladder capacityBladder capacity of 100 mL or greater is required for screening trial consideration

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for sacral nerve stimulation (SNS) procedures and devices listed in the policy coding section. Confirm prior authorization rules and benefit requirements with the member's federal, state, or contractual plan before scheduling services.

Affected codes: see Applicable Codes section (CPT, HCPCS, ICD-10 groups)
Check plan-specific benefit coverage and preauthorization portals prior to service

Documentation Required

Staged Test and Conservative Therapy Documentation

A staged test (screening) stimulation trial is expected before permanent implantation. Documentation should show a clinically meaningful response — commonly defined as ≥50% improvement in baseline symptoms during the test stimulation — before proceeding to permanent device implantation.

Staged test documentation: baseline voiding/frequency diaries and comparison data during trial

Background and Evidence Summary

Sacral nerve stimulation (SNM) places an electrode near the sacral nerves to modulate bladder and pelvic‑floor function. A brief screening trial (commonly a percutaneous nerve evaluation or staged lead test) is used to assess response—successful test stimulation is typically defined as ≥ 50% improvement in one or more target urinary or bowel symptoms—and permanent implantation is offered only when trial criteria and other coverage conditions are met.

Coverage considerations reference multiple evidence sources: network meta‑analysis and large comparative reviews (for example Liu et al. 2022 and Hayes assessments) that compare SNM with antimuscarinics, mirabegron, botulinum toxin, and PTNS; randomized controlled trials (for example Elterman et al. 2021) that define trial‑phase success and device settings; and systematic reviews/meta‑analyses (for example van Ophoven et al.) summarizing pooled test and permanent success rates and common adverse events. These evidence elements inform the requirement for prior conservative therapy, the value of a successful test phase, and expectations about effectiveness and risks.

Guidelines support SNM for specific indications when conservative care has failed: major urology and continence societies (AUA/SUFU, EAU, ICS) endorse SNM as a third‑line option for refractory overactive bladder/urge urinary incontinence and as a treatment for non‑obstructive urinary retention in selected patients; gastroenterology societies (ACG, AGA, ASCRS) support SNM for moderate‑to‑severe fecal incontinence after conservative measures. Conversely, guideline panels note limited or insufficient evidence for SNM in constipation and many chronic pelvic pain presentations.

Definitions and Key Terms

inv-49: Chronic Urinary Retention — PVR ≥ 300 mL persisting for ≥6 months and documented on ≥2 occasions

DefinitionChronic urinary retention: PVR ≥ 300 mL persisting for ≥ 6 months

Documentation requirementMust be documented on ≥ 2 separate occasions

ReferenceDefinition cited from policy Definitions section (Stoffel et al., 2016)

inv-50: Fecal Incontinence — Involuntary passage of fecal matter; severity ranges

DefinitionFecal Incontinence: involuntary passage of fecal matter or inability to control discharge of bowel contents

Severity rangeSeverity ranges from involuntary passage of flatus to complete evacuation of fecal matter

Policy Revision History

2026-05-01policy_revisionLatest

Policy revised: replaced references to 'Sacral Nerve Stimulation' with 'Sacral Nerve Stimulation (neurostimulation)', added definition of Fowler's Syndrome, and updated medical records documentation requirements for coverage reviews.

2026-05-01codes_added

Added ICD-10 diagnosis codes R35.81, R39.191, and R39.192 to the Applicable Codes (urinary indications).

2026-05-01supporting_sections_updated

Updated Clinical Evidence, FDA, and References sections to reflect current information and archived previous policy version CS358ID.A.

Policy Summary

PayerUnitedHealthcare

PolicySacral Nerve Stimulation for Urinary and Fecal Indications (for Idaho Only)

Policy CodePolicy CS358ID.B

Change TypeContent updates and additions (definitions, documentation, ICD-10 codes)

Effective DateMay 1, 2026

Next Review Date

Key ActionObtain prior authorization and include documentation of conservative therapy failure and a ≥50% symptom improvement during a test stimulation before requesting permanent implantation.

SourceLink

On This Page

Anatomic suitability:

Lack of distorted anorectal anatomy (e.g., anorectal malformation, abscess/fistula, prior rectal surgery)

Risk/benefit and alternatives: Consider comparative risks: botulinum toxin has higher rates of UTI and urinary retention requiring catheterization; SNM often yields greater reductions in UI episodes and frequency at 12 weeks and favorable long-term outcomes in many series

Comparative findings summarized from network meta-analyses and RCTs

after conservative therapy failure

Systematic reviews show greater pain improvement in non-BPS/IC etiologies and limited evidence for IC/BPS

Constipation / Slow transit constipation (STC): Evidence insufficient/inconclusive to support routine use of SNM for refractory idiopathic slow transit constipation; randomized trials show conflicting results and long-term effectiveness and cost-effectiveness are uncertain.insufficient evidence

Multiple systematic reviews and RCTs cited with conflicting outcomes

Neurogenic lower urinary tract dysfunction (nLUTD) / neurogenic bladder: Evidence is limited but suggests possible benefit in carefully selected neurogenic patients (e.g., MS, spinal pathology) with low risk of upper tract deterioration; success rates may be similar to non-neurogenic populations in some series, but overall evidence quality is low and more studies needed.careful selection, refractory to conservative care

Systematic reviews show improvements in multiple urodynamic and diary parameters but heterogeneity exists

Constipation/Slow-transit constipation: SNM may be effective for chronic constipation with successful PNE when conservative measures fail, but evidence is limited and US FDA approval is lacking for this indication.

ASCRS notes lack of consistent evidence; not FDA approved for constipation in US

Denial triggerScreening trial or permanent implantation may be denied if bladder capacity <100 mL

Source criteriaListed among required criteria for urinary voiding dysfunction screening trial

inv-26: Chronic urinary retention definition (PVR) — ≥ 300 mL on ≥2 occasions over ≥6 months (key value)

Chronic urinary retention (PVR)Postvoid residual (PVR) ≥ 300 mL

DurationPersists for ≥ 6 months

Documentation frequencyDocumented on ≥ 2 separate occasions

inv-27: Test success threshold — >= 50% improvement in one or more troublesome urinary or bowel parameters (key value)

Test success threshold>= 50% improvement in one or more troublesome urinary or bowel parameters during PNE or Stage 1 test period

Alternate success metricReturn to normal voiding defined as <8 voids/day for frequency indications (used in trials)

Typical test durationsPNE: 7 days (bladder) / 10–21 days (bowel); Stage 1: typically 2–3 weeks

Permanent implant requires documented ≥50% improvement in reported symptoms during screening trial

Step Therapy

Conservative Therapy Prerequisite and Third-Line Placement

Patients must have symptoms refractory to conservative care before a screening trial is authorized. Conservative care includes behavioral therapies (bladder/bowel training, pelvic floor rehabilitation), pharmacologic therapy, and other noninvasive measures as appropriate for the indication.

Conservative therapy prerequisite: documentation of prior behavioral and pharmacologic therapies and responses
SNS, PTNS, and botulinum toxin are considered third-line options after failure of behavioral and pharmacologic therapies

Documentation Required

Medical Records Documentation Requirements

Medical records must fully support the medical necessity for the requested services. Records may be requested to verify whether clinical criteria are met and insufficient documentation may result in denial of coverage.

Required documentation includes: relevant medical history, physical examination, diagnostic test results, baseline voiding or bowel diaries, and documentation of conservative therapy trials
Records should be legible, maintained in the patient chart, and made available upon request

Documentation Required

Typical Required Documentation for SNM

Typical documentation used to evaluate eligibility for SNM includes baseline and on-trial symptom measures and objective data that demonstrate response to test stimulation.

Baseline voiding or bowel diaries and symptom frequency/severity measures
Documentation of conservative therapy attempts and responses (dates, medications, therapy types)
Test stimulation records showing percentage improvement (commonly ≥50%) and clinician assessment

Documentation Required

Trial Phase and Follow-up Expectations

The temporary test/trial stimulation phase is the best predictor of long-term therapeutic success and is required to assess potential benefit prior to permanent implantation. Failure to achieve sufficient clinical response during the trial is an absolute contraindication to permanent implant.

Use trial phase results to predict therapeutic success and need for permanent device
Denial trigger: insufficient clinical response to a therapeutic trial (e.g., <50% improvement)

Documentation Required

Consent and Specialist Unit Documentation

Informed consent must include discussion of risks, the need for possible additional surgeries (revision/removal), device limitations (battery life, MRI considerations), long-term commitment to follow-up, and the possibility of device removal if ineffective. Ensure patients are cognitively capable of operating the device or have adequate caregiver support.

Document that consent discussion covered risks, likelihood of revision, surveillance needs, and device removal scenarios
Confirm and document the patient (or caregiver) is capable of operating the SNM device

Denial Risk

Evidence Limitations May Affect Coverage

Evidence limitations — including small sample sizes, heterogeneous populations, short-term follow-up, and risk of bias in some studies — may affect coverage decisions. Where evidence is insufficient or inconsistent for a particular indication (for example, constipation or chronic pelvic pain), coverage may be considered not medically necessary.

Limitations cited in the literature may trigger coverage denials for indications lacking adequate evidence
Refer to Coverage Rationale and Supporting Evidence sections for indication-specific guidance

ContextListed in policy Definitions section (Shah and Villanueva Herrero, 2022)

inv-51: Sacral Nerve Stimulation (SNS/SNM) — definition of the therapy (key value)

DefinitionSacral Nerve Stimulation (SNS/SNM): placement of a small electrode tip near the sacral nerve to stimulate afferent fibers, acting as a pacemaker to improve urinary and fecal function

Other namesAlso known as Sacral Neuromodulation (SNM) or Urologic Nerve Stimulation

IndicationsUsed for OAB, UUI, non-obstructive urinary retention, and fecal incontinence among other investigational uses

inv-52: Successful test stimulation — Defined as ≥50% improvement or return to normal voiding (<8 voids/day) per trials

Success definitionSuccessful test stimulation: ≥50% improvement in urinary incontinence or urinary frequency symptoms or return to normal voiding (<8 voids/day)

Trial importanceSuccessful test stimulation demonstrated in trials predicts likelihood of permanent implant benefit

Trial evidenceElterman et al. defined successful test stimulation this way in their prospective RCT

inv-53: PNE (percutaneous nerve evaluation) / trial phase — Temporary test stimulation phase used to assess response prior to permanent implant

DefinitionPNE (percutaneous nerve evaluation): a temporary test stimulation phase used to assess patient response to neuromodulation prior to permanent implant

RoleRegarded as the most valued predictor of potential therapeutic success before implantation

Typical durationsPNE typically 7 days for bladder indications and 10–21 days for bowel indications

inv-54: Refractory OAB/UUI — Overactive bladder or urgency urinary incontinence not responding to behavioral and pharmacologic therapies

Definition of refractoryRefractory OAB/UUI: overactive bladder or urgency urinary incontinence not responding to behavioral and pharmacologic therapies

Place in therapySNM is considered a third-line option after failure of conservative and pharmacologic treatments

Guideline supportEAU and AUA/SUFU guidelines support offering SNM for refractory OAB/UUI

inv-55: PNE (Percutaneous Nerve Evaluation) — Typical durations: 7 days (bladder) / 10-21 days (bowel)

Typical PNE durationsPNE: typically 7 days for bladder indications; 10–21 days for bowel indications

Stage 1 alternativeStage 1 testing used when longer test period is needed; duration typically 2–3 weeks

Repeat testingA repeat Stage 1 test may be performed at physician discretion if PNE results are inconclusive

inv-56: Stage 1 testing — Temporizing lead implantation test phase, typically 2-3 weeks

Stage 1 testingTemporizing lead implantation test phase typically lasting 2–3 weeks used when longer screening is required

PurposeUsed when PNE is inconclusive or a longer test period is desired to assess response

Repeat optionClinician may repeat Stage 1 test at discretion

inv-57: Fowler's Syndrome — Definition added to policy (text present in full source)

DefinitionFowler's Syndrome: characterized by large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity

Typical populationTypically occurs in post‑menarche young women in their second and third decades of life

Policy noteDefinition was added to the policy in the recent revision

inv-58: Sacral Nerve Stimulation (neurostimulation) — Updated terminology/definition in policy

Updated terminologyPolicy uses 'Sacral Nerve Stimulation (neurostimulation)' replacing earlier references to SNS/SNM

Core definitionImplantation of electrode near sacral nerve to modulate bladder/pelvic floor function (acts as pacemaker)

SynonymsAlso referred to as Sacral Neuromodulation (SNM) or Urologic Nerve Stimulation in the document

inv-59: Urge Incontinence — Updated definition in policy

Primary success thresholdSuccessful test stimulation is defined as ≥50% improvement in one or more urinary symptoms during the test phase

Alternate metricReturn to normal voiding (<8 voids/day) also used as success for frequency indications

ImplicationAchievement of this threshold during PNE or Stage 1 supports offering complete system implantation