ModifiedUnitedHealthcarePolicy CS358KY.05

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

Policy governing use of sacral nerve stimulation (SNS/SNM) for urinary voiding dysfunction and fecal incontinence in adults; applies to Kentucky only and describes when screening trials, permanent implantation, revisions/replacements, and exclusions are considered medically necessary or not.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS358KY.05

Change TypeDefinitions and documentation clarificationminor wording updates

Effective DateApr 1, 2026

Next Review Date

Key ActionPrior authorization must document failed conservative and pharmacologic therapy and a successful test-phase stimulation (typically ≥50% symptom improvement) before permanent SNM implantation.

SourceLink

POLICY UPDATE CHANGES

Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that medical records documentation may be required to assess clinical criteria for coverage.

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

Added definition for 'Sacral Nerve Stimulation (SNS) [Also Known as Sacral Neuromodulation]'.

Updated definition of 'Urge Incontinence' and updated Supporting Information sections (Clinical Evidence, FDA, References).

≥50%symptom improvement threshold required after screening trial to qualify for permanent implantation

3-7 daystypical duration of SNS screening trial

≥18

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age requirement for this policy

≥300 mLchronic urinary retention PVR threshold

7d / 10-21dPNE test durations (bladder/bowel)

InterQual®external criteria source used

Coverage Criteria for Sacral Nerve Stimulation

inv-01: Screening trial — urinary indications — Covered when ALL of the following are met

Sacral nerve stimulation (SNS/SNM) coverage is conditional on documentation, trial success, and absence of contraindications. Covered when ALL of the following are met:

ALL of the following

Indication: Lower urinary tract symptoms (eg, overactive bladder/urgency-frequency, urge urinary incontinence, nonobstructive urinary retention) or fecal incontinence not secondary to neurologic disease and not due to a mechanical obstruction or distorted anorectal anatomy.
Conservative therapy: Symptoms refractory to appropriate conservative management (urinary: bladder training, pelvic floor rehab, pharmacologic therapy; bowel: bowel training, bulking agents, pelvic floor rehabilitation, pharmacologic therapy). Prior use of and inadequate response or intolerance to first- and second-line therapies documented.
Third-line sequencing: SNS/SNM is considered a third-line therapy after failure of behavioral and pharmacologic therapies and when other guideline-recommended, less-invasive third-line options (eg, onabotulinumtoxinA for urinary indications, PTNS where appropriate) have been considered or tried as clinically indicated.
Trial stimulation requirement: A documented screening/test stimulation phase of typically 3–7 days (or as otherwise clinically appropriate) with prospectively collected symptom monitoring (eg, voiding diary for urinary indications; 2–3 week bowel diary for fecal indications) before permanent implantation.
Test-phase success threshold: Demonstrated improvement in reported symptoms of ≥50% during the trial phase, or return to normal voiding (eg, <8 voids/day) when applicable, documented in the medical record and diary data.
Bladder/bowel function thresholds: For urinary indications, documented bladder capacity ≥100 mL when assessed and no bladder outlet/mechanical obstruction; for bowel indications, absence of constipation as the primary cause when treating fecal incontinence.
Functional ability: Individual (or caregiver support) must be capable of operating and complying with long‑term management of the device; documentation of capability or availability of supportive caregivers required.
Device replacement/revision: Replacement or revision is considered medically necessary when prior criteria were met, the existing device is nonfunctional, cannot be repaired, or is no longer under warranty; clinical justification and prior device history must be provided.
Documentation and surveillance expectations: Medical record must include pre-test documentation (indication, prior conservative treatments tried and responses, relevant exam/diagnostic testing), prospective symptom diaries for baseline and trial phases, trial stimulation parameters and duration, objective and subjective outcome measures showing ≥50% improvement, informed consent discussing long-term commitment, risk of revision, MRI considerations, and plan for lifelong surveillance where indicated.

inv-02: Permanent implantation — urinary indications — Covered when ALL of the following are met

Permanent implantation is covered when ALL of the following are met:

ALL of the following

All screening trial criteria have been met and are documented in the medical record.
Successful screening/test-phase defined as ≥50% improvement in reported symptoms (or return to normal voiding parameters when applicable) with corroborating diary data and clinician assessment.
Pre-implant documentation: operative plan, confirmation of trial success, risks/benefits discussion, device type and MRI compatibility considerations, and plan for long-term follow-up and reprogramming/revision management.
Evidence-limit denial risk: Provider should be aware that indications lacking comparative randomized evidence (eg, chronic constipation, chronic pelvic pain) are considered investigational or not medically necessary per policy; documentation of indication-specific rationale and acknowledgment of limited evidence is necessary but does not guarantee coverage.

inv-03: Screening trial — fecal incontinence — Covered when ALL of the following are met

Screening trial for fecal incontinence — Covered when ALL of the following are met:

ALL of the following

Fecal incontinence diagnosis with symptoms refractory to conservative care (eg, bowel training, bulking agents, pelvic floor rehabilitation, pharmacologic therapy) documented.
Not secondary to neurologic disease or to constipation; absence of distorted anorectal anatomy (eg, active abscess, fistula, recent rectal surgery) documented.
Pre-test documentation: baseline 2–3 week bowel diary required before test stimulation; relevant anorectal physiology testing (eg, manometry) may be considered to characterize dysfunction and is recommended when available.
Trial stimulation: documented test-phase (duration and parameters) with prospective bowel diary showing clinical response; successful test defined as ≥50% improvement in symptoms or other pre-specified responder criteria documented.

inv-04: Permanent implantation — fecal incontinence — Covered when ALL of the following are met

Permanent implantation for fecal incontinence — Covered when ALL of the following are met:

ALL of the following

All fecal incontinence screening trial criteria have been met and documented, including baseline and trial bowel diaries showing response.
Successful screening/test-phase with ≥50% improvement in reported symptoms corroborated by bowel diary and clinician assessment.
Pre-implant documentation: informed consent, discussion of alternative treatments, device type and compatibility, plan for long-term follow-up and likely need for revisions.

inv-05: Replacement or revision — 1 top-level node

Replacement or revision — Covered when ALL of the following are met:

ALL of the following

Individual previously met coverage criteria for initial SNS implantation and medical records documenting prior trial success and implantation exist.
Existing device is nonfunctional, cannot be repaired, or is no longer under warranty; clinical justification and device history provided.
No absolute contraindication present at time of revision/replacement (see contraindications node).

inv-06: Unproven / Not medically necessary indications — 1 top-level node

Unproven / Not medically necessary indications — The following are considered NOT medically necessary or investigational:

ANY of the following

SNS/SNM for chronic constipation or chronic pelvic pain — considered investigational or not medically necessary due to insufficient or conflicting evidence of safety and efficacy.
Permanent implantation without a documented, successful trial phase meeting the ≥50% improvement threshold and required diary documentation.
Use of SNS for indications where high-quality comparative randomized evidence is lacking and guideline bodies advise against routine use; providers should document rationale but be aware of denial risk.

inv-07: Implied coverage criteria for neuromodulation therapies — Coverage considerations where SNM or PTNS may be considered medically necessary when ALL of the following are met

Implied coverage criteria / general considerations — SNS or PTNS may be considered medically necessary when ALL of the following are met:

ALL of the following

Clinical selection: Patient selection should follow specialty society guidance (AUA/SUFU, EAU, ICS, AGA, ASCRS) with documentation of prior therapies and appropriateness for neuromodulation.
Pre-test elements: medical history, physical exam, relevant diagnostics (eg, post-void residual, urodynamics when indicated), baseline symptom diaries (urinary or 2–3 week bowel diary), and documentation of failed conservative therapies.
Test-phase monitoring and success: Prospective diaries collected at baseline and during the test phase; success defined as ≥50% improvement in symptoms or other validated response metrics documented in the record.
Operating capability and consent: Documented patient (or caregiver) ability to operate device, informed consent acknowledging risks (lead migration, infection, need for revisions, MRI limitations), and long-term commitment.

inv-08: Indication-specific coverage/evidence statements — Guideline and evidence-based positions for SNM by indication

Indication-specific coverage/evidence statements and guideline positions — summarize guidance used to inform coverage decisions:

ALL of the following

Specialty guidance: AUA/SUFU, EAU, ICS, ASCRS, AGA and NICE generally support SNM for refractory OAB and FI when conservative measures fail and recommend a trial phase and long-term surveillance; these positions inform coverage but individual plan terms and evidence limitations apply.
Evidence limitations and denial risk: For constipation and certain chronic pelvic pain indications, evidence is insufficient or conflicting; routine permanent implantation for refractory constipation is not supported by available evidence and may be denied.

inv-09: Initial coverage criteria — Covered when specialty society guidance and test-phase criteria are met

Initial coverage criteria — Covered when specialty society guidance and test-phase criteria are met:

ALL of the following

Documentation of indication and failure of conservative therapies; baseline and trial diaries submitted as part of prior authorization when requested.
Successful test-phase as defined (≥50% symptom improvement) with clinician corroboration and diary evidence.
Acknowledgment of device risks and plan for long-term follow-up documented in the medical record and prior authorization materials.

Coding and Test Thresholds

Procedure CPT 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.

HCPCS Supply 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.

Diagnosis CodesICD-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.
R30.0	Dysuria.
R30.1	Vesical tenesmus.

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inv-22: Screening trial response — key metric (>= 50% improvement in reported symptoms)

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

Use for permanent implantationImprovement ≥50% required to qualify for permanent implant

Typical trial length referencedTrial typically 3–7 days for screening trial

inv-23: Bladder capacity — key metric (>= 100 mL)

Minimum bladder capacityBladder capacity ≥ 100 mL required

Context of measurement

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior authorization required for listed SNM procedure and supply codes

Prior authorization is required for the listed procedure and supply codes when used for sacral nerve stimulation procedures and implantable components; diagnosis codes are provided for reference related to indications in the policy.

Affected procedure codes include: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595.
Affected HCPCS supply codes include: L8679, L8680, L8682, L8685, L8686, L8687, L8688.

Prior Authorization

Verify prior therapy failure and successful test stimulation

Prior authorization should confirm documentation of failed conservative and pharmacologic therapies and evidence of a successful test stimulation (commonly defined as ≥50% symptom improvement) before approving permanent SNM implantation.

Successful test stimulation commonly defined as ≥50% improvement in UI, urinary frequency, or return to normal voiding (<8 voids/day).
Document prior conservative/pharmacologic therapy failure or intolerance.

Background and Evidence Summary

Sacral nerve stimulation (also called sacral neuromodulation) places an electrode adjacent to the sacral nerve roots and delivers electrical stimulation via an implanted pulse generator to modulate bladder, pelvic floor, and bowel function. It is used for overactive bladder (including urgency urinary incontinence), nonobstructive urinary retention, and for fecal incontinence in selected patients after conservative therapies have failed.

A temporary trial (percutaneous nerve evaluation or stage 1 test) is typically performed to predict response prior to permanent implantation; a test-phase response of ≥ 50% improvement in target symptoms during the trial is commonly required to proceed to permanent implantation.

Definitions

inv-49: Chronic Urinary Retention — PVR >= 300 mL definition and persistence criteria

PVR threshold for chronic retentionPostvoid residual (PVR) ≥ 300 mL

Persistence criteriaPVR ≥300 mL persisting ≥ 6 months and documented on ≥2 separate occasions

Associated termReferred to as Chronic Urinary Retention in definitions

inv-50: Fecal Incontinence — definition

DefinitionInvoluntary passage of fecal matter or inability to control discharge of bowel contents (range: flatus to complete evacuation)

Trial documentation for FIA 2–3 week bowel diary is needed before the SNM test for bowel dysfunction

Revision History

2026-04-01policy_revisionLatest

Replaced references to 'Sacral Nerve Stimulation' with 'Sacral Nerve Stimulation (neurostimulation)' and added detailed medical records documentation language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that medical records may be required to assess clinical criteria for coverage (documentation must fully support medical necessity and be made available upon request).

definition_added

Added definition for 'Sacral Nerve Stimulation (SNS) [Also Known as Sacral Neuromodulation]'.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS358KY.05

Change TypeDefinitions and documentation clarificationminor wording updates

Effective DateApr 1, 2026

Next Review Date

SourceLink

On This Page

Surveillance expectations: Lifelong surveillance recommended for implanted individuals to monitor for lead displacement, device malfunction, battery depletion, and adverse events; document follow-up plan.

Contraindications: Absolute contraindications (pregnancy, inability to operate device without supportive caregivers, insufficient clinical response to trial) preclude coverage; relative contraindications (severe/rapidly progressive neurologic disease, complete SCI, anticipated need for MRI of body parts below head, abnormal sacral anatomy) must be documented and may affect authorization decisions.

Medical record documentation requirements: Provide pre-test documentation (indication, prior therapies and dates, objective testing), trial stimulation details (dates, parameters, diary data), clinician assessment of response, and plan for permanent implantation if criteria met. Documentation does not guarantee coverage; federal/state/contractual requirements govern.

Requirement applies to urinary screening trial eligibility

Age applicabilityPolicy applies to individuals ≥ 18 years of age

inv-24: Test-phase responder threshold — >= 50% improvement in one or more troublesome parameters

Test-phase responder threshold>= 50% improvement in one or more troublesome urinary or bowel parameters during PNE or Stage 1

Outcome measures usedSuccess defined by symptom reduction or return to normal voiding (eg, <8 voids/day)

Evidence supportMeta-analyses and guidelines reference 50% as common trial success threshold

inv-25: PNE duration — typical durations (7 days bladder; 10-21 days bowel)

PNE duration — bladder indicationsTypically 7 days for bladder screening

PNE duration — bowel indicationsTypically 10–21 days for bowel screening

PurposeShort-duration screening to identify candidates for complete system implantation

inv-26: Stage 1 test duration — typical duration 2-3 weeks

Stage 1 test durationTypical duration is 2–3 weeks for Stage 1 (test lead) evaluation

When usedEmployed when PNE is inconclusive or a longer evaluation is needed

Repeat testingRepeat Stage 1 testing may be performed at physician's discretion

Prior Authorization

Trial stimulation required; bowel diary for bowel indications

A trial (test) phase is required prior to permanent implantation and, for bowel dysfunction, a 2–3 week bowel diary must be completed before the SNM test; anorectal physiology testing can be considered to further characterize dysfunction.

Trial phase (PNE or Stage 1) is the most valued predictor of therapeutic success.
Bowel diary duration: 2–3 weeks prior to test stimulation.

Prior Authorization

Ensure conservative therapy failure and documented test-phase success

Prior authorization should document failure or intolerance of conservative and medical therapies and recorded successful test-phase stimulation, typically defined as ≥50% improvement during PNE or Stage 1 testing.

PNE typical durations: 7 days for bladder; 10–21 days for bowel.
Stage 1 test period typically 2–3 weeks; success threshold ≥50% improvement in one or more target symptoms.

Note

Criteria sources and prior authorization guidance

UnitedHealthcare references InterQual® as the primary medical/surgical criteria source and may use Medical Policies, Coverage Determination Guidelines, or Utilization Review Guidelines when InterQual® does not have applicable criteria; check federal, state, or contractual requirements before using this policy.

When conflicts exist, federal, state, or contractual requirements govern coverage decisions.

Step Therapy

Conservative therapy required before SNM

Patients must have symptoms refractory to conservative care (behavioral measures, pelvic floor rehabilitation, and pharmacologic therapy) before considering SNM screening trial or implantation.

Conservative care examples: bladder/bowel training, pelvic floor rehabilitation, bulking agents, pharmacologic therapy.

Step Therapy

Third-line sequencing: SNM, PTNS, BTX

SNM, PTNS, and botulinum toxin are described as third-line options after behavioral and pharmacologic therapy; PTNS is noted as a minimally invasive alternative to SNM though comparative evidence is limited.

PTNS is considered a minimally invasive alternative; comparative long-term evidence versus SNM is limited.

Step Therapy

Conservative therapy prerequisite and treatment sequencing

Guidelines recommend SNM as a third-line therapy for overactive bladder/urgency urinary incontinence after failure of conservative and medical therapies, and as a second-line option for fecal incontinence after conservative measures have failed.

Offer SNM for OAB/UUI refractory to anticholinergic or other medical therapy.
Consider SNM for bothersome fecal incontinence after failed conservative treatment.

Step Therapy

Placement of SNM in treatment sequence after failed therapies

SNM is indicated after failure of conservative and medical therapies for OAB and is presented as a later-line option relative to conservative measures and botulinum toxin in some guidelines; prior therapies and test-phase response should be documented.

Document prior conservative and medical therapy failure; confirm successful trial stimulation (≥50% improvement) before permanent implant.

Documentation Required

Medical record documentation must support medical necessity

The patient's medical record must include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures that fully support medical necessity; records must be legible and available upon request.

Documentation should demonstrate indication, prior therapies tried, and objective/validated outcome measures where applicable.

Documentation Required

Clinical documentation elements required for authorization

Required documentation should include prior failed conservative and pharmacologic therapies, validated outcome measures (voiding/bowel diaries, ICIQ‑OABqol, PGI‑I, St. Mark's/Wexner scores), and evidence of test stimulation success (commonly ≥50% improvement).

Include voiding or bowel diaries and validated symptom scores when available.
Record test-phase improvement percentage and test type (PNE or Stage 1).

Documentation Required

Pre-test bowel diary and optional anorectal testing

For bowel dysfunction, obtain a 2–3 week bowel diary before the SNM test and consider anorectal physiology testing (manometry, sensation, volume tolerance) to characterize dysfunction.

Anorectal physiology testing is optional to guide management and clarify candidacy.

Documentation Required

Document trial results (≥50%) and preoperative counseling

Document trial stimulation results showing ≥50% improvement in one or more target urinary or bowel symptoms and that preoperative counseling covered lifelong follow-up, battery replacement, potential complications, and reprogramming or revision risks.

Note PNE or Stage 1 duration and measurable symptom change used to determine success.

Documentation Required

Maintain legible, reviewable medical records supporting necessity

Patient medical records must contain legible documentation that fully supports medical necessity, including relevant history, exam findings, and results of diagnostic tests; records may be requested for review.

Maintain documentation of prior therapies, test-phase data, and informed consent discussions.

Denial Risk

Denial risk: missing screening-trial eligibility criteria

Failure to meet all listed criteria for a screening trial—such as age ≥18, bladder capacity ≥100 mL, non-neurologic origin of symptoms, absence of bladder outlet/mechanical obstruction, refractory symptoms to conservative care, and ability to operate the device—may lead to denial of coverage for the screening trial.

Ensure documentation demonstrates each required screening-trial criterion before submission.

Denial Risk

Denial risk due to evidence limitations

Evidence limitations—small sample sizes, heterogeneous populations, lack of comparative randomized trials, and risk of bias—may be cited as reasons for denial of coverage when clinical benefit is uncertain, especially for less-established indications.

Indications like constipation and some chronic pelvic pain syndromes have limited or conflicting evidence and higher denial risk.

Note

Trial-phase importance and long-term surveillance expectation

The trial phase is emphasized as the most valuable predictor of SNM success; guidelines also recommend life‑long surveillance for implanted devices, so expect documentation or monitoring plans to be relevant to authorization decisions.

Trial-phase results should be clearly recorded; plans for long-term follow-up and device surveillance are expected for implanted patients.

Denial Risk

Absolute contraindications that preclude coverage/implantation

Absolute contraindications that would preclude implantation and coverage include insufficient clinical response to the therapeutic trial, incapability to operate the device without supportive caregivers, and pregnancy.

If any absolute contraindication is present, implantation is contraindicated and coverage may be denied.

Denial Risk

Relative contraindications that affect authorization

Relative contraindications—severe progressive neurologic disease, established complete spinal cord injury, expected need for MRI below the head, or abnormal sacral anatomy—may increase risk of denial or require individualized review and consideration.

These conditions do not automatically exclude coverage but may necessitate special consideration or additional documentation.

Denial Risk

Denial risk: incomplete documentation or unmet contractual requirements

Coverage may be denied if the member's medical record does not fully support medical necessity for the requested services or if federal, state, or contractual requirements for benefit coverage are not met; documentation must be made available upon request.

Ensure records include history, exam, prior therapies, diagnostic test results, and trial-phase outcome data to reduce denial risk.

Therapy sequencingSNM is a second-line option for bothersome FI after failure of conservative measures

inv-51: Sacral Nerve Stimulation (SNS/SNM) — definition (implantation of electrode near sacral nerve)

DefinitionImplantation of a small electrode tip placed near the sacral nerve with an implanted neurostimulator to modulate voiding and pelvic floor function

Alternate nameAlso known as sacral neuromodulation (SNM) or urologic nerve stimulation

Clinical useUsed for overactive bladder, urge incontinence, non-obstructive urinary retention, and fecal incontinence

inv-52: Successful test stimulation — commonly defined as >=50% improvement in target symptoms

Common trial definitionSuccessful test stimulation commonly defined as ≥50% improvement in target symptoms (eg, urinary incontinence, frequency) or return to normal voiding

Trial-to-implant pathwayDemonstrated success during test phase used to select patients for permanent implantation

Reported ratesClinical trials frequently use ≥50% threshold to report test-phase responders

inv-53: Trial (test) phase — description of percutaneous nerve evaluation or test lead

DescriptionTrial (test) phase is a temporary stimulation period (percutaneous nerve evaluation or test lead) used to predict therapeutic success prior to permanent implant

Forms of trialIncludes PNE (short percutaneous evaluation) or Stage 1 test lead implantation for longer assessment

ValueGuidelines state the trial phase is the most valued tool for predicting SNM success

inv-54: NOUR / NOUR — Non-obstructive urinary retention definition and indication context

DefinitionNon-obstructive urinary retention (NOUR): urinary retention without mechanical obstruction; indication context: SNM has demonstrated efficacy in selected patients

Guideline positionICS and EAU recognize SNM as an option for NOUR in selected patients

Clinical noteNOUR may be part of broader non-neurogenic lower urinary tract dysfunction indications

inv-55: PNE — Percutaneous nerve evaluation typical durations and screening use

PNE descriptionPercutaneous nerve evaluation is a short-duration test stimulation used to screen candidates for SNM

Typical durationsTypically 7 days for bladder indications and 10–21 days for bowel indications

PurposeUsed as a screening tool to predict therapeutic success before permanent implantation

inv-56: Stage 1 testing — description and typical duration (2-3 weeks)

DescriptionStage 1 testing involves implantation of a test lead for a longer trial period to evaluate response

Typical durationTypically 2–3 weeks for Stage 1 testing

IndicationUsed when PNE is inconclusive or a longer evaluation is required

inv-57: Sacral Nerve Stimulation (SNS) — definition added/updated in policy (alternate phrasing: sacral neuromodulation)

Definition (policy update)Sacral Nerve Stimulation (SNS) also referred to as sacral neuromodulation — definition added/updated in policy

Terminology changePolicy replaced references with 'Sacral Nerve Stimulation (neurostimulation)'

Clinical descriptionSmall electrode tip placed near sacral nerve with implanted neurostimulator acting as a pacemaker for bladder

inv-58: Urge Incontinence — updated definition

Definition updatedUrge Incontinence: sudden compelling urges to void resulting in involuntary leakage of urine (Urge Urinary Incontinence, UUI)

Policy noteDefinition of Urge Incontinence updated in the policy revisions

Clinical contextUrge Incontinence is a form of urinary incontinence addressed by SNM indications