Skip to main content

HCPCS/CPT E0736, Transcutaneous tibial nerve stimulator | Prior Auth Required

Backwork Sign up free

Ask Backwork/E0736

`E0736`, Transcutaneous tibial nerve stimulator

HCPCS/CPT

Prior Authorization

Prior Auth Required

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

Key Coverage Criteria

An initial 12-week trial ofpercutaneoustibial nerve stimulation is consideredmedically necessarywhen the following criteria are met (AandB):
Anyof the following are present for at least 3 months, and not due to a neurological condition:Urinary urge incontinence;orUrinary urgency/frequency;orNon-obstructive urinary retention;and
Urinary urge incontinence;or
Urinary urgency/frequency;or
Non-obstructive urinary retention;and
Criteria 1and2 below are met:Clinically significant symptoms are present (for example, frequency, or severity impacts ability to work or participate in activities outside of the home);andSymptoms are refractory to, or individual could not tolerate, conservative treatment (for example, medication, pelvic floor muscle exercises, pelvic floor physical exercises with biofeedback, bladder training, or intermittent catheterizations for non-obstructive urinary retention) for at least a sufficient durat [...]

6 Active Policies

ANTHEM-CG-SURG-126, Tibial Nerve Stimulation

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

BCBSIL-MED205.035, Tibial Nerve Stimulation

BCBSMT-MED205.035, Tibial Nerve Stimulation

BCBSNM-MED205.035

Related Codes

64566(5 policies)A4545(5 policies)E0737(5 policies)0589T(4 policies)0818T(4 policies)0816T(4 policies)64999(4 policies)0590T(4 policies)

Have a follow-up question?

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

Ask Backwork about E0736 Sign up free

, Tibial Nerve Stimulation

BCBSOK-MED205.035, Tibial Nerve Stimulation