The North American Neuromodulation Society (NANS) has joined seven national medical specialty societies in signing a joint letter urging Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma, and Texas—as well as the Health Care Services Corporation—to revise their draft policy on implantable peripheral nerve stimulation (PNS) for chronic pain.
The letter, submitted on October 14, 2025, expresses serious concern with draft policy MED 205.042, which classifies PNS as “experimental, investigational, or unproven.” The signatories emphasize that this classification is inconsistent with the growing body of evidence demonstrating that PNS is an effective and safe treatment option for chronic pain.
Key Points Highlighted in the Letter
- Clinical Evidence: More than 50 clinical studies, including Level I randomized controlled trials, show that PNS effectively treats conditions such as chronic migraine, neuropathic pain, complex regional pain syndrome (CRPS), and post-amputation pain.
- Medicare Coverage: PNS is supported under both national and local Medicare coverage determinations–NCD 160.7 and LCD L34328—affirming its medical necessity for chronic pain management.
- Patient Outcomes: Real-world data demonstrate an average pain reduction of 69% and improved function, mobility, and quality of life after PNS implantation, with a particularly low rate of adverse events.
- Cost and Safety: Studies have shown that PNS can halve total medical costs while reducing opioid use by more than 30%, offering a cost-effective and minimally invasive option compared to surgery.
Why It Matters
Coverage decisions that fail to reflect current clinical evidence can delay access to proven therapies, forcing patients toward more invasive or less effective options. By updating PNS coverage policies to align with the latest evidence and federal guidelines, payers can help ensure that patients receive comprehensive, compassionate, and cost-effective care.