Peripheral Nerve Stimulation
JE · Effective Oct 1, 2015
8 active Medicare policies list 64590, and 55 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
JJ · Effective Nov 5, 2023
JM · Effective Nov 5, 2023
National · Effective Oct 23, 2025
National · Effective Jun 17, 2025
National · Effective Apr 6, 2026
National · Effective Mar 5, 2026
55 policies from 14 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 64590 |
|---|---|---|
| Bariatric Surgery | Not recorded | Covered |
| Diaphragmatic/Phrenic Nerve Stimulation | Not recorded | Covered |
| Fecal Incontinence Treatments | Not recorded | Covered |
| Gastric Electrical Stimulation | Not recorded | Covered |
| Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation | Not recorded | Covered |
| Urinary Incontinence Devices and Treatments | Not recorded |
| Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | Oct 1, 2026 | Covered |
| Gastric Electrical Stimulation | Jan 6, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | Jan 6, 2026 | Covered |
| Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures) | Oct 1, 2026 | Not covered |
| Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Bariatric Surgery and Procedures | Jul 15, 2026 | Not covered |
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Diaphragmatic/Phrenic Nerve Stimulation | Jul 15, 2026 | Covered with conditions |
| Headache, Occipital, and/or Trigeminal Neuralgia Treatment | Jun 15, 2026 | Not covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Medical Policies Moving to MCG Guidelines | Jan 1, 2026 | Covered |
| Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | Oct 15, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Medical Policies Moving to MCG Guidelines | Jan 1, 2026 | Covered |
| Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | Oct 15, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Medical Policies Moving to MCG Guidelines | Jan 1, 2026 | Covered |
| Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | Oct 15, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Medical Policies Moving to MCG Guidelines | Jan 1, 2026 | Covered |
| Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | Oct 15, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Gastric Electrical Stimulation | Jul 1, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field Stimulation | Sep 1, 2026 | Covered |
| Occipital Nerve Stimulation | Jun 1, 2026 | Covered |
| Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Bariatric Surgery – Surest Medical Policy | May 1, 2026 | Covered |
| Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases – Surest Medical Policy | Aug 1, 2026 | Covered |
| Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) | Oct 1, 2026 | Covered |
| Sacral Nerve Stimulation for Urinary and Fecal Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Bariatric Surgery | May 1, 2026 | Covered |
| Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases | Aug 1, 2026 | Covered |
| Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) | Oct 1, 2026 | Covered |
| Sacral Nerve Stimulation for Urinary and Fecal Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Bariatric Surgery | May 1, 2026 | Covered |
| Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases | Aug 1, 2026 | Covered |
| Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) | Oct 1, 2026 | Covered |
| Sacral Nerve Stimulation for Urinary and Fecal Indications | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy | Sep 25, 2023 | Covered |
| Headaches: Invasive Procedures | Feb 20, 2024 | Covered |
| Peripheral Electrical Nerve Stimulation for Pain | Feb 8, 2024 | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Electrical Stimulators | Not recorded | Covered |
| Gastroesophageal and Gastrointestinal (GI) Services and Procedures | Not recorded | Covered |
| Urinary and Fecal Incontinence: Diagnosis and Treatment | Not recorded | Covered |
| Policy | Effective | Status of 64590 |
|---|---|---|
| Nerve Stimulation for Urinary Incontinence | Apr 1, 2026 | Covered |