Medical policy
Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve…
Empire Blue medical policy CG-SURG-95 · Jan 30, 2025
Key facts
| Policy title | Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention |
|---|---|
| Insurer | Empire Blue |
| Policy number | CG-SURG-95 |
| Policy date | Jan 30, 2025 |
| Current policy | Yes |
| ICD-10 codes | 01HY0MZ, 01HY3MZ, 01HY4MZ |
| Insurer page | empireblue.com |
At a glance
- 1–9 510(k)s referenced
- 1–9 PMAs referenced
- None De Novos referenced
- 1–9 Clinical trials referenced
- 10–99 Articles referenced
- None UDI devices referenced
- None NDC products referenced
Counts are shown as ranges. Exact figures, trends and every underlying record are available in Orca1.
About Insurer medical policies
Insurer clinical and medical policies state when a payer covers a device, drug or procedure. Orca1 links each policy to the FDA submissions, trials and articles it cites. Policy text is not reproduced here.
Source: Health insurer clinical and medical policies (insurer as listed); cross-links by Orca1