Evicore auths for SCS? No Nevro?

[thecentral09]

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Hey all, I recently obtained the new 2019 evicore comprehensive musculoskeletal management guideline regarding SCS. What I found was interesting suggesting that high frequency spinal cord stimulation remains experimental, investigational, and unproven for ANY Indication. I do not use it frequently as I typically utilize firs indication. I do not use it frequently as I typically use Burst, but found this surprising.

 

[drusso]

Hey all, I recently obtained the new 2019 evicore comprehensive musculoskeletal management guideline regarding SCS. What I found was interesting suggesting that high frequency spinal cord stimulation remains experimental, investigational, and unproven for ANY Indication. I do not use it frequently as I typically utilize firs indication. I do not use it frequently as I typically use Burst, but found this surprising.

"Not everything paid for works; not everything that works is paid for..."

 

[lobelsteve]

Hey all, I recently obtained the new 2019 evicore comprehensive musculoskeletal management guideline regarding SCS. What I found was interesting suggesting that high frequency spinal cord stimulation remains experimental, investigational, and unproven for ANY Indication. I do not use it frequently as I typically utilize firs indication. I do not use it frequently as I typically use Burst, but found this surprising.

It says any other indication. So it is indicated for something. Likely FBSS, M96.1

 

[paindoc007]

It says any other indication. So it is indicated for something. Likely FBSS, M96.1

Correct. Okay for post lami and critical limb ischemia, not crps

 

[Agast]

From the page before it:

CMM-211.2: Indications
The determination of medical necessity for implantation of a dorsal spinal cord stimulator is always made on a case-by-case basis.
Chronic Intractable Pain Secondary to Failed Back Surgery Syndrome  A short-term trial (e.g., greater than 48 hours) spinal cord stimulation [i.e., low frequency, high-frequency (HF 10 SCS)] is considered medically necessary for the treatment of chronic, intractable pain secondary to failed back surgery syndrome (FBSS) with intractable neuropathic leg pain

The other approved indications for SCS do specify that it is for low frequency stimulation (CRPS, chronic angina pectoris etc)

Nevro can do low frequency stim as well so if you really really want to use it, you can make that argument

 

[Orin]

Just to provide the link to the guidelines:

eviCore - Page Not Found

www.evicore.com

I think this is an example of the chickens coming home to roost for Nevro with their marketing, branding, and pricing model. The key thing here is that putting in a HF10 only system would be a problem by their guidances. Their battery is capable of doing non-HF10 stimulation, but so can every other battery, so why should a healthcare system pay the Nevro surcharge or deal with the MRI conditionality issue or the size or the charge burden etc.

CMM-211.4: Non-Indications  A high frequency spinal cord stimulator is considered experimental, investigational, or unproven for ANY other indication, including CRPS/RSD.

"As an alternative to traditional dorsal spinal column stimulation, HF10 SCS is proven safe and effective for treatment of chronic, intractable low back and leg pain in patients with failed back surgery syndrome"

Based on the above, HF10 is covered for FBSS by eviCore's guidance for leg/back pain specifically, but not the other usual/unusual indications for SCS.

Evicore doesn't want to argue about swapping a non-Nevro system to Nevro.
 Replacement of a functioning non high-frequency dorsal column spinal cord stimulator with a high frequency spinal cord stimulator is considered not medically necessary

The Nevro reps need training in tonic, as it seems to suggest programming modes outside of tonic are not covered.
"Generator modes other than tonic low and high frequency (e.g., burst stimulation) is considered experimental, investigational, or unproven. "
It is also complicated as the definition of high frequency is weird here.

They seem to not like HF10 but are okay with burst stimulation that is "tonic high frequency stimulation" as compared to just regular high frequency. I'm not sure where they fall on the Medtronic "high density" stimulation that gets to one kilohertz, but seems okay with BoSci/Abbott's waveforms.

That's just all wird though.