Cigna Healthcare (Commercial) · peripheral nerve stimulation

v2verified 2026-07-24manual-pull source

✗ investigational / not covered · commercial

Criteria checklist

0 of 5 ticked

Indications

enumerated: yes
covered:
investigational:
- implantable peripheral nerve stimulation (PNS) for acute or chronic pain — not medically necessary
- peripheral nerve FIELD stimulation (PNfS) — experimental/investigational/unproven

Conservative care

required: not stated in the policy
note: n/a — not covered

Trial

required: no
min duration days: not stated in the policy
success criteria: not stated in the policy
threshold is binding: no

Psychological evaluation

required: no
must clear: no
note posture: n/a

Quantity limits

applies: no

Payor-specific notes

Cigna (mm_0539) deems implantable PNS "not medically necessary" for acute/chronic pain and PNfS experimental/investigational; eviCore CMM-211 also lists PNS (incl. PNfS) as EIU. More restrictive than Medicare (NCD 160.7-A covers PNS). From the actual fetched Cigna policy.

Ticks are a documentation aid — nothing is stored; they reset on reload.

Dot phrase

Cigna (mm_0539) deems implantable PNS **not medically necessary** and PNfS experimental/ investigational.

.PNSCIGNA

This patient would be a candidate for peripheral nerve stimulation, but PNS is not a covered
benefit under this plan: Cigna mm_0539 deems implantable PNS not medically necessary and
peripheral nerve field stimulation experimental and investigational. My clinical rationale is
documented here: *** . Alternatives have been discussed with the patient. Any appeal must
contest the not-medically-necessary / EIU position itself.

Cautions

Medicare covers PNS under NCD 160.7-A.
Regenerate if `cigna-commercial-pns.md` `version` advances.

Prior-auth pathway

required: not stated in the policy
note: n/a — denied

Provenance

authority:
- type: commercial_policy
- id: Cigna mm_0539
- title: Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation
- applies because: Cigna coverage policy mm_0539 governs PNS/PNfS (eviCore CMM-211 also lists PNS as EIU)
source: https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0539_coveragepositioncriteria_percut_periph_nerve_stim_field_stim.pdf
archived copy: sources/cigna_mm0539-pns-pnfs_2026-03-15.pdf (sha256 17cea584de30… — kept in the content repo, not served here)
effective: 2026-03-15 · payor last reviewed: 2026-03-15 · we verified: 2026-07-24 · v2

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Change history

2026-07-24commercial cells: re-verify 27 source PDFs by SHA-256 (Carelon/eviCore/UHC/Cigna) - all unchanged vs committed archive; last_verified -> 2026-07-24 3615c231f0
2026-07-23pns/cigna v2: coverage_status not_addressed -> investigational 69241abdd0
2026-06-30Archive commercial source PDFs into sources/ + wire source_file/source_hash c5466694c8
2026-06-29Add commercial PNS cells: Anthem, UHC, Cigna (all deny generic PNS) afaa8358cc