Does C1816 require prior authorization?

Yes, C1816 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

Backwork Sign up free

`C1816`, Receiver and/or transmitter, neurostimulator (implantable)

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
For some interventional procedures/trials, pre-procedure evaluations included medical/neurological and psychological examinations, depression rating scales (e.g., Montgomery–Asberg Depression Rating Scale), and lumbar puncture with CSF analysis.
Documentation of prior/concurrent standard therapies (e.g., use of cholinesterase inhibitors and/or memantine) is often recorded in trials and may be relevant when considering investigational add-on therapies.
None specified in this policy document. (The CPB lists investigational/experimental treatments and codes not covered; it does not define separate documentation requirements for coverage of the listed items.)
None specified in this document excerpt.
Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.

Key Coverage Criteria

None specified. This Clinical Policy Bulletin addresses experimental treatments for Alzheimer's disease and lists treatments considered experimental and investigational (i.e., not established as effective) for this indication.
No explicit covered indications are stated in this document. The document discusses potential therapeutic use in the following conditions:
Alzheimer's disease (AD)
mild cognitive impairment (MCI)
amnestic MCI
pre-clinical AD

20 Active Policies

ANTHEM-CG-MED-79, Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-844835841DE9, Cigna Commercial Interventional Pain Management Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-47F76AA38AE6, Cigna Medicare Advantage Interventional Pain Management Code List - Effective 01/01/2025

CIGNA-0391, Diaphragmatic/Phrenic Nerve Stimulation

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

AETNA-CPB-0511, Eating Disorders

AETNA-CPB-0614, Huntington's Disease

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0253, Vocal Cord Paralysis / Insufficiency Treatments

AETNA-CPB-0755, Motor Cortex Stimulation

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0406, Tinnitus Treatments

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

AETNA-CPB-0191, Vagus Nerve Stimulation

AMBETTER-CP.MP.203, Diaphragmatic/Phrenic Nerve Stimulation

AMBETTER-CP.MP.12, Vagus Nerve Stimulation

BCBSIL-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSIL-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

BCBSMT-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about C1816 Sign up free

C1816, Receiver and/or transmitter, neurostimulator (implantable)

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
For some interventional procedures/trials, pre-procedure evaluations included medical/neurological and psychological examinations, depression rating scales (e.g., Montgomery–Asberg Depression Rating Scale), and lumbar puncture with CSF analysis.
Documentation of prior/concurrent standard therapies (e.g., use of cholinesterase inhibitors and/or memantine) is often recorded in trials and may be relevant when considering investigational add-on therapies.
None specified in this policy document. (The CPB lists investigational/experimental treatments and codes not covered; it does not define separate documentation requirements for coverage of the listed items.)
None specified in this document excerpt.
Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.

Key Coverage Criteria

None specified. This Clinical Policy Bulletin addresses experimental treatments for Alzheimer's disease and lists treatments considered experimental and investigational (i.e., not established as effective) for this indication.
No explicit covered indications are stated in this document. The document discusses potential therapeutic use in the following conditions:
Alzheimer's disease (AD)
mild cognitive impairment (MCI)
amnestic MCI
pre-clinical AD

20 Active Policies

ANTHEM-CG-MED-79, Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-844835841DE9, Cigna Commercial Interventional Pain Management Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-47F76AA38AE6, Cigna Medicare Advantage Interventional Pain Management Code List - Effective 01/01/2025

CIGNA-0391, Diaphragmatic/Phrenic Nerve Stimulation

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

AETNA-CPB-0511, Eating Disorders

AETNA-CPB-0614, Huntington's Disease

AETNA-CPB-0707, Headaches: Invasive Procedures

AETNA-CPB-0253, Vocal Cord Paralysis / Insufficiency Treatments

AETNA-CPB-0755, Motor Cortex Stimulation

AETNA-CPB-0362, Spasticity Management

AETNA-CPB-0406, Tinnitus Treatments

AETNA-CPB-0374, Trigeminal Neuralgia: Treatments

AETNA-CPB-0191, Vagus Nerve Stimulation

AMBETTER-CP.MP.203, Diaphragmatic/Phrenic Nerve Stimulation

AMBETTER-CP.MP.12, Vagus Nerve Stimulation

BCBSIL-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

BCBSIL-SUR712.009, Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation

BCBSMT-MED205.042, Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about C1816 Sign up free

`C1816`, Receiver and/or transmitter, neurostimulator (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C1816`, Receiver and/or transmitter, neurostimulator (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C1816, Receiver and/or transmitter, neurostimulator (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C1816, Receiver and/or transmitter, neurostimulator (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C1816`, Receiver and/or transmitter, neurostimulator (implantable)

`C1816`, Receiver and/or transmitter, neurostimulator (implantable)