Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence
JJ · Effective Nov 5, 2023
5 active Medicare policies list A4290, and 8 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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JJ · Effective Nov 5, 2023
JM · Effective Nov 5, 2023
National · Effective Jun 17, 2025
National · Effective Apr 6, 2026
National · Effective Mar 5, 2026
8 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of A4290 |
|---|---|---|
| Levator Syndrome Treatments | Sep 19, 2023 | Covered |
| Pelvic Congestion Syndrome Treatments | Jun 14, 2023 | Covered |
| Policy | Effective | Status of A4290 |
|---|---|---|
| Fecal Incontinence Treatments | Not recorded | Covered |
| Urinary Incontinence Devices and Treatments | Not recorded | Covered |
| Policy | Effective | Status of A4290 |
|---|
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
|---|
| Policy | Effective | Status of A4290 |
|---|---|---|
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of A4290 |
|---|---|---|
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Policy | Effective | Status of A4290 |
|---|---|---|
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |