Attached is the NCD to also review for your appeal to demonstrate criteria was actually met and that it was denied in error.
http://www.cms.gov/medicare-coverag...DId=240&ncdver=1&DocID=160.7&bc=gAAAABAAAAAA&
B - Central Nervous System Stimulators (Dorsal Column and Depth Brain Stimulators)
The implantation of central nervous system stimulators may be covered as therapies for the relief of chronic intractable pain, subject to the following conditions:
1 - Types of Implantations
There are two types of implantations covered by this instruction:
•Dorsal Column (Spinal Cord) Neurostimulation - The surgical implantation of neurostimulator electrodes within the dura mater (endodural) or the percutaneous insertion of electrodes in the epidural space is covered.
•Depth Brain Neurostimulation - The stereotactic implantation of electrodes in the deep brain (e.g., thalamus and periaqueductal gray matter) is covered.
2 - Conditions for Coverage
No payment may be made for the implantation of dorsal column or depth brain stimulators or services and supplies related to such implantation, unless all of the conditions listed below have been met:
•The implantation of the stimulator is used only as a late resort (if not a last resort) for patients with chronic intractable pain;
•With respect to item a, other treatment modalities (pharmacological, surgical, physical, or psychological therapies) have been tried and did not prove satisfactory, or are judged to be unsuitable or contraindicated for the given patient;
•Patients have undergone careful screening, evaluation and diagnosis by a multidisciplinary team prior to implantation. (Such screening must include psychological, as well as physical evaluation);
•All the facilities, equipment, and professional and support personnel required for the proper diagnosis, treatment training, and followup of the patient (including that required to satisfy item c) must be available; and
•Demonstration of pain relief with a temporarily implanted electrode precedes permanent implantation.