Cigna Healthcare (Commercial) · restorative neurostimulation

v1verified 2026-07-24needs re-verificationmanual-pull source

✗ investigational / not covered · commercial

Criteria checklist

0 of 5 ticked

Indications

enumerated: yes
covered:
investigational:
- implantable restorative peripheral nerve (field) stimulation for lumbar multifidus dysfunction (ReActiv8) — experimental/investigational/unproven for any indication

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) classes ReActiv8 under restorative peripheral nerve FIELD stimulation, which the policy deems experimental/investigational/unproven for any indication (literature review cites insufficient evidence for implantable restorative PNS for lumbar multifidus; FDA PMA P190021, Mainstay). UNCERTAINTY: no ReActiv8-specific coverage line exists — the determination is inferred from the PNFS/restorative EIU position statement (needs_reverification). Contrast: Anthem covers ReActiv8; UHC also denies. From the fetched Cigna policy.

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

Dot phrase

Cigna (mm_0539) classes ReActiv8 under restorative peripheral nerve field stimulation and deems it **experimental/investigational/unproven**.

.REACTIV8CIGNA

This patient would be a candidate for ReActiv8 restorative neurostimulation, but it is not a
covered benefit under this plan: Cigna mm_0539 classes ReActiv8 under restorative peripheral
nerve field stimulation and deems it experimental, investigational, and unproven. My clinical
rationale is documented here: *** . Alternatives have been discussed with the patient. Any
appeal must contest the EIU position itself.

Cautions

Anthem covers ReActiv8; UHC also denies it.
[!] No ReActiv8-specific coverage line in mm_0539 — status inferred from the PNFS EIU position. Regenerate if `cigna-commercial-reactiv8.md` `version` advances.

Prior-auth pathway

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

Provenance

authority:
- type: commercial_policy
- id: Cigna mm_0539
- title: Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation (restorative PNFS)
- applies because: Cigna mm_0539 classes ReActiv8 under restorative peripheral nerve field stimulation
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 · v1

Report an issue with this cell

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
2026-06-30Archive commercial source PDFs into sources/ + wire source_file/source_hash c5466694c8
2026-06-29Add commercial ReActiv8 cells: Anthem (covered), UHC, Cigna (investigational) f768ceb667