RetiredUnitedHealthcarePolicy CS358LA.E

Sacral Nerve Stimulation (SNS) for urinary and fecal indications

Policy governs medical necessity, indications, and coding for sacral nerve stimulation (neurostimulation) for adult members in Louisiana, covering screening trials, permanent implantation, revisions/replacements, and noncovered indications.

Policy Summary

PayerUnitedHealthcare

PolicySacral Nerve Stimulation (SNS) for urinary and fecal indications

Policy CodePolicy CS358LA.E

Change TypeRetireddocumentation and terminology updates

Effective DateFebruary 1, 2026 - March 31, 2026

Next Review DateN/A

Key ActionObtain and maintain medical record documentation demonstrating prior conservative therapy and successful test stimulation (≥50% symptom improvement) for authorization and medical necessity review.

SourceLink

POLICY UPDATE CHANGES

Retired policy; Louisiana plan membership disenrolled on Apr. 1, 2026.

Added language clarifying that medical records documentation may be required to assess clinical criteria and that documentation must support medical necessity.

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

Removed notation that CPT codes 64585 and 64595 are not on the State of Louisiana Medicaid Fee Schedule.

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

2026-04-01Policy retirement date

50%Required screening improvement

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Min bladder capacity

≥18Age of applicability

Coverage Criteria for Sacral Nerve Stimulation (SNS)

inv-01: SNS screening trial (urinary)

Covered when ALL of the following are met

Urinary SNS screening trial criteria: Lower urinary tract symptoms: overactive bladder symptoms, urge incontinence, or nonobstructive urinary retention (NOUR)

From policy coverage rationale

Bladder capacity of 100 ml or greater>=100 mL

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

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

Failure of conservative care: Symptoms refractory to conservative care (bladder training, pelvic floor rehabilitation, pharmacological therapy)

Patient capability: Individual capable of operating sacral nerve stimulating device

inv-02: Permanent SNS implantation (urinary)

Covered when ALL of the following are met

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

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

inv-03: SNS screening trial (fecal)

Covered when ALL of the following are met

Refractory symptoms: Symptoms refractory to conservative care (bowel training, bulking agents, pelvic floor rehabilitation, pharmacological therapy)

Patient capability: Individual capable of operating sacral nerve stimulating device

Neurologic origin excluded: 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

No distorted anatomy:

inv-04: Permanent SNS implantation (fecal)

Covered when ALL of the following are met

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

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

inv-05: SNS replacement or revision

Covered when ALL of the following are met

Prior indications met: Individual has met all above criteria for SNS

Device nonfunctional or not repairable: Existing device is nonfunctional and cannot be repaired or is no longer under warranty

inv-06: Unproven / Not Medically Necessary Indications

Unproven indications: SNS for treatment of Constipation and Chronic Pelvic Pain is considered unproven and not medically necessary due to insufficient evidence of safety and/or efficacy.

inv-07: Evidence-based coverage considerations

Coverage considerations reflected by the evidence (descriptive; specific payer criteria not provided in this excerpt):

General candidate criteria: Individuals considered for SNM typically have refractory symptoms after behavioral and pharmacologic therapies and must demonstrate a successful test stimulation (commonly defined as ≥50% symptom improvement) prior to permanent implantation.≥50% improvement during test stimulation

Supported by multiple trials and technology assessments.

Urinary indications with supportive evidence: Overactive bladder (OAB), urinary urge incontinence (UUI), non-obstructive urinary retention (NOUR), and neurogenic lower urinary tract dysfunction (nLUTD) have evidence of benefit with SNM, including RCTs, systematic reviews, and meta-analyses showing reductions in UI episodes and improvements in QoL.

SNM often demonstrated greater reduction in UI episodes versus comparators in network meta-analyses; pooled permanent SNM success ~84% in meta-analysis.

Fecal indications: Chronic fecal incontinence and low anterior resection syndrome (LARS) have evidence of benefit from SNM with improvements in incontinence scores and QoL; randomized crossover trial showed symptom improvement when device active.

inv-08: Guideline-supported Indications

Covered when ALL of the following are met for guideline-supported indications

Overactive bladder / Urgency urinary incontinence (OAB/UUI): Patient has OAB/UUI refractory to or intolerant of behavioral and pharmacologic therapies and is a candidate for third-line therapy with SNM; clinician documents informed consent and patient willingness for surgical implantation and long-term device management.refractory after appropriate conservative therapy

Supported by AUA/SUFU, EAU, ICS guidance

Fecal incontinence (FI): Patient has moderate to severe FI not responsive to conservative measures and biofeedback; SNM may be considered per gastroenterology and colorectal guidance (ACG/AGA/EAU).failure of conservative therapy ≥3 months where applicable

Supported by ACG (strong recommendation for FI), AGA best practice advice

Non-obstructive urinary retention (NOUR)/Idiopathic urinary retention:

inv-09: Indications with Insufficient / Mixed Evidence

Not routinely covered or considered investigational when ANY of the following apply

Constipation / slow transit constipation (STC): Evidence is insufficient and mixed (RCTs with conflicting results; systematic reviews conclude insufficient/inconclusive evidence); SNS not routinely recommended for constipation outside clinical trials.insufficient evidence

Heemskerk 2024, systematic reviews conclude lack of robust evidence

Chronic pelvic pain (CPP) / interstitial cystitis / BPS: Evidence is low quality and inconsistent; some studies show improvement in subgroups but overall limited and heterogeneous data — not routinely supported except in carefully selected cases or trials.limited evidence

Mahran 2019, Tutolo 2018, Hernández-Hernández 2021 findings

Neurogenic lower urinary tract dysfunction (nLUTD) secondary to neurologic disease:

inv-10: Covered Indications (guideline-based)

Covered when guideline-based selection criteria are met (examples below drawn from EAU, ICS, and NICE statements):

Refractory OAB/UUI: Patient has overactive bladder (with or without incontinence) that is refractory to or intolerant of conservative and medical therapies (including anticholinergics); consider SNM after failure of these measures or when botulinum toxin is unacceptable or failed.as above

EAU, ICS, NICE recommendations support offering SNM after conservative/medical therapy failure

Test stimulation success: Patient achieves >=50% improvement in one or more troublesome urinary or bowel parameters during PNE or Stage 1 test period.>=50% improvement

ICS guidance for offering full implantation after successful trial

Indications beyond OAB: SNM may be considered for refractory urinary retention, fecal incontinence, selected constipation cases with successful PNE, and certain pelvic floor dysfunctions when conservative therapy has failed.

SNS is not covered when the presenting urinary or fecal dysfunction is secondary to neurologic disease (for example, Parkinson disease, stroke, spinal cord injury, or multiple sclerosis), when there is bladder outlet or other mechanical obstruction (e.g., BPH, tumor, prior pelvic radiation, urethral stricture), when fecal incontinence is secondary to constipation, or when distorted anorectal anatomy is present (for example, anorectal malformation, abscess/fistula, or prior rectal surgery).

Patients with chronic refractory nonobstructive urinary retention (NOUR) who do not demonstrate an adequate response during the initial test phase are frequently not candidates for permanent SNS implantation; the evidence and technology assessments note inadequate response to initial testing as a common reason to exclude progression to permanent implant.

The evidence for SNS to treat constipation (including refractory idiopathic slow transit constipation) is inconsistent and insufficient. Multiple systematic reviews and randomized trials report conflicting results and methodological limitations; therefore SNS for constipation is not supported as routine therapy and is considered unproven outside of clinical studies.

Absolute contraindications include insufficient clinical response to a therapeutic trial, inability of the individual to operate the device without adequate caregiver support, and pregnancy. Relative contraindications include severe or rapidly progressive neurologic disease, established complete spinal cord injury, anticipated need for MRI of body regions below the head, and abnormal sacral anatomy.

This policy is informational and does not supersede specific plan terms. Federal, state, or contractual benefit plan requirements govern if they differ from the policy; verify applicable benefit plan language when coverage decisions conflict.

Sacral nerve stimulation for Constipation and Chronic Pelvic Pain is considered unproven and not medically necessary due to insufficient evidence of safety and/or efficacy; these indications are not accepted as standard covered uses.

Available studies for chronic pelvic pain are limited, heterogeneous, and generally low quality; systematic reviews conclude that additional high-quality randomized trials are required before SNS can be recommended for chronic pelvic pain as a general indication.

Permanent implantation is not supported for individuals with refractory constipation who only responded to temporary nerve stimulation: randomized crossover trials and systematic reviews failed to demonstrate consistent benefit of active stimulation over sham, and therefore permanent implant after a temporary response is not recommended.

Procedure, Device, and Diagnosis Codes

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 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.

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.

1–10 of 32

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Applicable CPT codes referenced in revision notesCPT

64585	Percutaneous implantation of neurostimulator electrode array; sacral nerve (document referenced prior notation removal)
64595	Insertion or replacement of peripheral or neurostimulator pulse generator or receiver, direct or inductive coupling (document referenced prior notation removal)

inv-23: Screening trial response — ≥ 50% improvement in reported symptoms

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

Definition sourcePolicy requires ≥50% improvement in reported symptoms to qualify for permanent implantation

Trial documentationImprovement should be documented using voiding diaries or validated instruments as reported in trials

inv-24: Bladder capacity minimum — ≥ 100 mL

Minimum bladder capacityBladder capacity ≥ 100 mL

Context

Provider Requirements, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for listed SNS procedure and device codes. Prior authorization for permanent implantation requires documentation of a successful test stimulation (screening trial) demonstrating clinically meaningful improvement during the test phase.

Successful test stimulation must be documented as ≥50% improvement in target symptoms (e.g., UI episodes or voiding frequency) or return to normal voiding (<8 voids/day) during the trial phase.
Affected codes include CPT and HCPCS/L-codes for sacral neurostimulation procedures and devices (see Applicable Codes).

Documentation Required

Device Indication Verification

Prior authorization and medical necessity review must verify that the implanted device's labeled indication matches the therapeutic intent and member’s diagnosis. Confirm which FDA-cleared/approved system is intended (e.g., Medtronic InterStim family, Axonics r‑SNM, Neuspera PMA indications) and that the indication aligns with conservative therapy failure and guideline-supported use.

Background and Context

Sacral nerve stimulation (SNS), also called sacral neuromodulation, is a minimally invasive implanted neuromodulation therapy that places an electrode near the sacral nerve and an implanted neurostimulator to modulate voiding and bowel function. It is an established therapy for select adults with overactive bladder, urgency urinary incontinence, nonobstructive urinary retention, and fecal incontinence, typically delivered after a brief screening test phase and reserved for patients who have failed conservative and medical therapies.

Definitions

inv-50: Chronic Pelvic Pain — definition

DefinitionChronic Pelvic Pain: persistent or recurrent episodic pelvic pain associated with lower urinary tract, sexual, bowel, or gynecological symptoms without proven infection or obvious pathology

Clinical featuresAssociated symptoms suggest lower urinary tract, sexual, bowel, or gynecological dysfunction

SourcePolicy definition (Fall et al., 2010) included in document definitions

inv-51: Chronic Urinary Retention — PVR ≥300 mL persisting ≥6 months and documented on ≥2 occasions

DefinitionChronic Urinary Retention: postvoid residual (PVR) ≥ 300 mL

Persistence requirementPVR persisting for ≥ 6 months

Quick Provider Checklist

Patient / Clinical Prerequisites

Note

Denial triggers (common)

Documentation, Coding & Authorization Actions

Unsupported block type: code_list

Note

Prior authorization considerations

Note

Documentation pitfalls to avoid

Policy Revisions and Notes

2026-04-01retirementLatest

Policy moved to retired status and Louisiana plan membership disenrolled on Apr. 1, 2026.

2026-02-01terminology_update_and_documentation_added

Replaced references to 'Sacral Nerve Stimulation' with 'Sacral Nerve Stimulation (neurostimulation)' and added detailed medical records documentation requirements to support medical necessity determinations.

[date not specified in chunk but recorded in revision history update]applicable_codes_update

Policy Summary

PayerUnitedHealthcare

PolicySacral Nerve Stimulation (SNS) for urinary and fecal indications

Policy CodePolicy CS358LA.E

Change TypeRetireddocumentation and terminology updates

Effective DateFebruary 1, 2026 - March 31, 2026

Next Review DateN/A

SourceLink

On This Page

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

≥50% reduction in LARS score used as an implant criterion in trial

Long-term studies report improvements but with heterogeneous evidence and notable revision/explant rates.

Chronic pelvic pain (CPP): Evidence for SNM in CPP is limited and mixed; systematic reviews report pain reduction and QoL improvement in case series but call for higher-quality RCTs before strong recommendations.

Insufficient high-quality evidence to firmly establish efficacy across CPP etiologies; some analyses show greater benefit outside BPS/IC etiology.

Device management considerations: Reprogramming and potential for revision/explant are reported; notable rates of reprogramming (e.g., 58% over 2 years in one RCT), revision, infection, pain, lead migration, and loss of effectiveness are described in multiple studies and assessments.

Providers should counsel patients on device-related risks and potential need for reintervention.

Patient with refractory idiopathic urinary retention who responded to test stimulation may be offered SNM after appropriate assessment.

test-phase responders

Supported by ICS and EAU statements

Evidence is mixed; some systematic reviews and cohort data indicate possible benefit in selected neurogenic patients, but overall evidence quality varies and broader recommendations are limited; careful selection required.

case-by-case consideration

Wei 2023, Schwarztuch 2024, Carolus 2025 report potential benefit in selected patients

clinical judgment and guideline support

ASCRS, NICE, EAU statements referenced

Bladder capacity requirement applies to SNS screening trial for urinary indications

Source statementPolicy states 'Bladder capacity of 100 ml or greater' as a screening criterion

inv-25: Chronic Urinary Retention PVR threshold — PVR ≥ 300 mL documented on ≥ 2 occasions over ≥ 6 months

Chronic urinary retention thresholdPostvoid residual (PVR) ≥ 300 mL

Duration and documentationPVR persists ≥ 6 months and is documented on ≥ 2 separate occasions

Definition citationDefined in policy as diagnostic criterion for Chronic Urinary Retention

inv-26: Test stimulation success threshold — 50% improvement in one or more troublesome urinary or bowel parameters

Test stimulation success threshold≥ 50% improvement in one or more troublesome urinary or bowel parameters during PNE or Stage 1 test

Trial-based definitionSuccessful test stimulation defined in trials as ≥50% improvement in UI or urinary frequency or return to normal voiding (<8 voids/day)

Use for implantation decisionIndividuals who achieve this threshold may be offered complete system implantation per ICS guidance

inv-27: PNE test duration — 7 days for bladder; 10-21 days for bowel

PNE test duration — bladderTypically 7 days for bladder indications

PNE test duration — bowelTypically 10–21 days for bowel indications

Guideline levelDurations cited as typical per ICS best practice statement (Level of Evidence: III)

inv-28: Stage 1 test duration — Typically 2-3 weeks

Stage 1 test durationTypically 2–3 weeks for Stage 1 lead testing

When usedStage 1 testing may be used if PNE is questionable or a longer screening period is needed; repeat stage 1 at physician discretion

Decision useStage 1 duration used to assess response prior to complete system implantation

Verify device PMA/clearance and labeled indications prior to authorization.
Document the specific device model and intended indication in the request.

Note

Device Durability and Selection Risk

Providers and reviewers should be aware of device durability, revision, and removal risks when counseling patients and during authorization review. Evidence and guideline reports note surgical revision/removal rates around 30%–40% by 3–4 years and the expectation of ongoing surveillance and possible battery replacement or revision surgeries.

Discuss long-term commitment, revision/removal risk, and expected need for follow-up and device maintenance in informed consent and medical records.

Denial Risk

Documentation Risk — Provide Complete Records

Failure to submit complete, legible medical records that demonstrate the clinical criteria and prior conservative management may result in denial or delay of authorization.

Include all relevant notes, test results, voiding diaries, prior therapy details, and documentation of intolerance or failure to prior therapies.
Medical records may be requested to substantiate medical necessity; absence of documentation may trigger noncoverage.

Documentation Required

Medical Record Documentation Requirements

The patient's medical record must fully support medical necessity for the requested SNS service. Documentation should include relevant history, focused physical examination, results of pertinent diagnostic tests/procedures, and clear rationale linking symptoms to the requested intervention.

Include symptom history (duration, severity), voiding diaries or frequency/incontinence episode counts, bladder capacity (≥100 mL when required), and exclusion of neurologic or mechanical causes.
Document prior conservative and pharmacologic therapies tried, doses/duration, reasons for discontinuation, and patient capability to operate the device.

Documentation Required

Informed Consent and Specialist Selection

Obtain and document informed consent that discusses risks, benefits, alternatives, the need for test stimulation, potential outcomes, and the likelihood of future revisions or device maintenance. Ensure the procedure is performed by an appropriately qualified specialist.

Informed consent should note potential adverse events (infection, lead migration, pain, electric shock), revision rates, and battery replacement needs.
Document the specialist's qualifications (urology, urogynecology, colorectal surgery) and that the patient understands long-term follow-up requirements.

Step Therapy

Conservative Therapy Required Prior to SNS

Conservative therapies must be attempted and documented prior to consideration of SNS. Evidence and guidelines designate behavioral therapies and pharmacologic agents as first- and second-line treatments; SNM is reserved for individuals refractory to these measures.

Document trials of bladder/bowel training, pelvic floor rehabilitation, antimuscarinics or beta‑3 agonists, and other appropriate conservative interventions, with duration and response.
If botulinum toxin was used, document response or intolerance; failure or intolerance to BTX may support consideration of SNS as a later-line option.

Step Therapy

Line of Therapy — Third-Line / After Conservative Therapy

SNM is generally a later-line (third-line) therapy after failure of first- and second-line options per professional guidelines. Prior authorization reviews will assess therapy sequencing and that SNS is being used in accordance with guideline-recommended treatment pathways.

Guidelines (AUA/EAU/ICS/NICE) describe SNM and PTNS as third-line options for refractory OAB after behavioral and pharmacologic therapy.
Authorization should note prior use and intolerance/failure of first- and second-line treatments and rationale for selecting neuromodulation.

Documentation requirementPVR must be documented on ≥ 2 separate occasions

inv-52: Fecal Incontinence — definition

DefinitionFecal Incontinence: involuntary passage of fecal matter or inability to control discharge of bowel contents, severity ranging from flatus leakage to complete evacuation

Clinical spectrumSeverity ranges from minor flatus leakage to complete evacuation

SourcePolicy definition (Shah and Villanueva Herrero, 2022)

inv-53: Sacral Nerve Stimulation (SNS) — definition of the therapy

Therapy descriptionSacral Nerve Stimulation (SNS): placement of a small electrode tip near the sacral nerve with an implanted neurostimulator to modulate voiding function

SynonymsAlso called sacral neuromodulation (SNM) or urologic nerve stimulation

Clinical useUsed to improve urinary function and reduce pain; originally for OAB, UUI, and NOUR and explored for FI, constipation, and CPP

inv-54: Successful test stimulation — defined as ≥50% improvement or return to normal voiding during test phase

Successful test stimulation definitionDefined as ≥50% improvement in urinary incontinence or urinary frequency or return to normal voiding (<8 voids/day) during evaluation phase

Trial usageUsed in trials (e.g., Elterman et al.) to determine candidacy for implantation

DocumentationSuccess typically documented with voiding diaries and validated QoL instruments

inv-55: Responder for LARS test phase — ≥50% reduction in LARS score during test stimulation (Marinello trial)

LARS responder definitionResponder in Marinello trial: ≥50% reduction in LARS score during test stimulation to qualify for implant

Trial outcome78% of participants achieved ≥50% reduction after testing in the trial

Use in implant decision≥50% LARS score reduction was required to proceed to pulse generator implant in the trial protocol

inv-56: trial phase / test phase (PNE) — temporary/staged neuromodulation test phase used to predict success

DefinitionTrial phase/test phase (PNE): a temporary or staged neuromodulation test used to predict therapeutic success before permanent implantation

ValueICS states the trial phase is the most valued tool for predicting SNM success for urinary indications

FormsIncludes percutaneous nerve evaluation (PNE) and Stage 1 lead testing

inv-57: PNE / Stage 1 test stimulation — typical durations (7 days bladder; 10–21 days bowel; Stage 1: 2–3 weeks)

Typical PNE durations7 days for bladder; 10–21 days for bowel indications

Stage 1 durationStage 1 test stimulation typically 2–3 weeks

Clinical noteStage 1 testing is used when longer screening is required or when PNE results are questionable

inv-58: Device PMA indications — InterStim, Axonics, Neuspera PMA identifiers cited

InterStim PMAInterStim PMA identifier: P970004 (approved for OAB and urinary retention)

Axonics PMAAxonics r-SNM PMA identifier: P190006 (approved for chronic fecal incontinence)

Neuspera PMANeuspera PMA identifier: P240031 (Neuspera system approved for UUI)

inv-59: Sacral Nerve Stimulation (SNS) — also known as Sacral Neuromodulation (SNM) or Urologic Nerve Stimulation

SynonymsSacral Nerve Stimulation (SNS) also known as Sacral Neuromodulation (SNM) or Urologic Nerve Stimulation

Terminology notePolicy replaced references to 'Sacral Nerve Stimulation' with 'Sacral Nerve Stimulation (neurostimulation)' in revision

Clinical implicationAll references to SNS/SNM are equivalent in the document's context

Removed prior state-specific notation about CPT codes 64585 and 64595 from the applicable codes section and refreshed supporting information; prior policy version archived.