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Dorsal column stimulator surgery4/15/2024 The results of the trial period must be documented in the PA attachments.The member must demonstrate at least a 50 percent reduction of pain with a temporarily implanted electrode.The member must complete a trial period of at least three days per the guidelines listed above for the temporarily implanted dorsal column stimulator electrodes for trial purposes.There is documentation that the pain interferes with a member's daily living activities.įor dorsal column stimulator surgery PA approval, the following criteria must be met:.Providing access to Full-Body MRI Scans, Precision Montage delivers Multiple Waveforms, all powered by Illumina 3D. Documented evidence of pathology of the chronic pain (i.e., an objective basis)Įxcept in unusual situations, the diagnosis should be either failed back surgery syndrome or complex regional pain syndrome. Precision Montage MRI Spinal Cord Stimulator System.Psychological and physical evaluation must confirm that the pain is not believed to be of psychological origin.The member must undergo careful screening, evaluation, and diagnosis by a multidisciplinary team prior to implantation.The implantation of the dorsal column stimulator is a treatment of late or last resort. What to Expect You may need to complete tests before the surgery (blood tests, EKG, or chest X-ray), as well as discuss any medications you’re taking with your doctor. Other treatment modalities (pharmacological, surgical, physical, or psychological therapies) have been given an adequate trial and did not prove satisfactory or were judged to be unsuitable or contraindicated for the member. The spinal cord stimulator (SCS) is surgically placed beneath the skin where thin wires carry the current to the nerve fibers.The member suffers from chronic, intractable pain.A separate PA is required for each.Īll of the following criteria must be met for PA requests to be approved for temporarily implanted dorsal column stimulator electrodes for trial purposes: PA is required for both a dorsal column (spinal cord) stimulator trial period and dorsal column implantation surgery. Topic #15557 Dorsal Column or Spinal Stimulator Surgeries
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