Does C1883 require prior authorization?

Yes, C1883 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`C1883`, Adapter/extension, pacing lead or neurostimulator lead (implantable)

HCPCS/CPT

Prior Authorization

Prior Auth Required

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

Documentation Required

Voiding diaries documenting baseline and test-stimulation outcomes are required to measure the ≥50% improvement for urinary indications.
For fecal incontinence, documentation must show frequency (>2 incontinent episodes/week), duration (>6 months or >12 months after vaginal childbirth), and failure or intolerance of conventional therapies.
A percutaneous test stimulation report documenting at least 50% sustained (>1 week) improvement is required to support permanent implantation for fecal incontinence.
Medical records must document that the patient is refractory to conventional therapy (behavioral, pharmacologic and/or surgical) for urinary indications and is an appropriate surgical candidate able to undergo anesthesia.
Records must document that the condition is not related to excluded causes (anorectal malformation, pelvic radiation sequelae, active anal abscess/fistula, chronic IBD, neurologic causes) when claiming coverage for fecal incontinence.
Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.

Key Coverage Criteria

Sacral nerve stimulation (SNS) is covered for urinary urge incontinence.
SNS is covered for urgency-frequency syndrome (urinary urgency-frequency).
SNS is covered for urinary retention.
Both a temporary test stimulation and subsequent permanent implantation of an implanted sacral electrode array are covered for appropriate candidates.
SNS is covered for fecal incontinence when all fecal-specific criteria are met (see limitations/frequency): chronic fecal incontinence with >2 incontinent episodes/week and duration >6 months or >12 months after vaginal childbirth.
Coverage for fecal incontinence requires documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).

20 Active Policies

PALMETTO-JJ-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

PALMETTO-JM-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

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

A53359, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A55835, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A59332, Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

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.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

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C1883, Adapter/extension, pacing lead or neurostimulator lead (implantable)

HCPCS/CPT

Prior Authorization

Prior Auth Required

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

Documentation Required

Voiding diaries documenting baseline and test-stimulation outcomes are required to measure the ≥50% improvement for urinary indications.
For fecal incontinence, documentation must show frequency (>2 incontinent episodes/week), duration (>6 months or >12 months after vaginal childbirth), and failure or intolerance of conventional therapies.
A percutaneous test stimulation report documenting at least 50% sustained (>1 week) improvement is required to support permanent implantation for fecal incontinence.
Medical records must document that the patient is refractory to conventional therapy (behavioral, pharmacologic and/or surgical) for urinary indications and is an appropriate surgical candidate able to undergo anesthesia.
Records must document that the condition is not related to excluded causes (anorectal malformation, pelvic radiation sequelae, active anal abscess/fistula, chronic IBD, neurologic causes) when claiming coverage for fecal incontinence.
Medical record documentation of prior conventional therapies tried and failed (behavioral, pharmacologic and/or surgical) must be provided for urinary indications.

Key Coverage Criteria

Sacral nerve stimulation (SNS) is covered for urinary urge incontinence.
SNS is covered for urgency-frequency syndrome (urinary urgency-frequency).
SNS is covered for urinary retention.
Both a temporary test stimulation and subsequent permanent implantation of an implanted sacral electrode array are covered for appropriate candidates.
SNS is covered for fecal incontinence when all fecal-specific criteria are met (see limitations/frequency): chronic fecal incontinence with >2 incontinent episodes/week and duration >6 months or >12 months after vaginal childbirth.
Coverage for fecal incontinence requires documented failure or intolerance to conventional therapy (e.g., dietary modification, bulking agents, pharmacologic treatment).

20 Active Policies

PALMETTO-JJ-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

PALMETTO-JM-L39543, Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

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

A53359, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A55835, Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence

A59332, Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence

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.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

Have a follow-up question?

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

Ask Backwork about C1883 Sign up free

`C1883`, Adapter/extension, pacing lead or neurostimulator lead (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C1883`, Adapter/extension, pacing lead or neurostimulator lead (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C1883, Adapter/extension, pacing lead or neurostimulator lead (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C1883, Adapter/extension, pacing lead or neurostimulator lead (implantable)

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C1883`, Adapter/extension, pacing lead or neurostimulator lead (implantable)

`C1883`, Adapter/extension, pacing lead or neurostimulator lead (implantable)