Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence
JJ · Effective Nov 5, 2023
5 active Medicare policies list C1767, and 62 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
62 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Showing 10 of 12 · All Aetna policies
| Policy | Effective | Status of C1767 |
|---|---|---|
| Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments | Feb 20, 2024 | Covered |
| Eating Disorders | Aug 1, 2023 | Covered |
| Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy | Sep 25, 2023 | Covered |
| Headaches: Invasive Procedures | Feb 20, 2024 | Covered |
| Huntington's Disease | Sep 12, 2023 | Covered |
| Motor Cortex Stimulation |
| Oct 6, 2023 |
| Covered |
| NeuroControl Freehand System | Jun 6, 2023 | Covered |
|---|
| Spasticity Management | Jun 21, 2023 | Covered |
|---|
| Tinnitus Treatments | Feb 16, 2024 | Covered |
|---|
| Trigeminal Neuralgia: Treatments | Feb 15, 2024 | Covered |
|---|
| Policy | Effective | Status of C1767 |
|---|---|---|
| Deep Brain Stimulation and Responsive Neurostimulation | 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 |
| Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring | Oct 1, 2026 | Covered |
| Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence | Oct 1, 2026 | Covered |
| Vagus Nerve Stimulation | Oct 1, 2026 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Deep Brain Stimulation | Sep 15, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Occipital Nerve Stimulation | Nov 15, 2025 | Covered |
| Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy | Dec 1, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Deep Brain Stimulation | Sep 15, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Occipital Nerve Stimulation | Nov 15, 2025 | Covered |
| Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy | Dec 1, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Deep Brain Stimulation | Sep 15, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Occipital Nerve Stimulation | Nov 15, 2025 | Covered |
| Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy | Dec 1, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Deep Brain Stimulation | Sep 15, 2026 | Covered |
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jan 1, 2026 | Covered |
| Occipital Nerve Stimulation | Nov 15, 2025 | Covered |
| Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy | Dec 1, 2025 | Covered |
| Sacral Nerve Neuromodulation/Stimulation | Dec 1, 2025 | Covered |
| Sleep Related Breathing Disorders: Surgical Management | Jan 1, 2026 | Covered |
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | Aug 1, 2026 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Fecal Incontinence Treatments | Not recorded | Covered |
| Gastric Electrical Stimulation | Not recorded | Covered |
| Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea | Not recorded | Covered |
| Vagus Nerve Stimulation | Not recorded | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Cigna Commercial Interventional Pain Management Code List | Mar 7, 2026 | Prior auth required |
| Cigna Commercial Sleep Management 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 |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Interventional Pain Management | Jun 14, 2026 | Covered |
| Sleep Disorder Management | Sep 19, 2026 | Covered |
| Sleep Disorder Management [for Wellpoint Massachusetts] | Nov 15, 2025 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Gastric Electrical Stimulation | Jul 1, 2026 | Covered |
| Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Dec 1, 2025 | Covered |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Cigna Medicare Advantage Interventional Pain Management Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of C1767 |
|---|---|---|
| Obstructive Sleep Apnea and Other Sleep Related Breathing Disorders Surgical Treatments | Jun 1, 2026 | Covered |