US · guidance
CMS Pub. 100-03, ch. 1, § 230.18
Sacral Nerve Stimulation for Urinary Incontinence
CIM 65-18
Effective January 1, 2002, sacral nerve stimulation is covered for the treatment of urinary urge incontinence,
urgency-frequency syndrome, and urinary retention. Sacral nerve stimulation involves both a temporary test
stimulation to determine if an implantable stimulator would be effective and a permanent implantation in
appropriate candidates. Both the test and the permanent implantation are covered.
The following limitations for coverage apply to all three indications:
• Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or
surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia
can occur.
• Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes
with peripheral nerve involvement) which are associated with secondary manifestations of the above three
indications are excluded.
• Patient must have had a successful test stimulation in order to support subsequent implantation.
Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater
improvement through test stimulation. Improvement is measured through voiding diaries.
• Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical
results of the implant procedure can be properly evaluated.
History
(Rev. 1, 10-03-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
92f9988b0cc222851b45151c7fedb3f23c964328df74142d3ba105c121fd2119
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