Medicare - Palmetto GBA
Palmetto Medicare has a positive coverage policy for PTNS. Palmetto Medicare covers 12 weeks of PTNS treatments. After the inital 12 sessions, ongoing treatments will be allowed for patients with the improved OAB symptoms of frequency, nocturia, urgency, voided volume and urge incontinence episodes at a frequency of 1 treatment every 1-2 months when medical necessity is supported by documentation in the medical record for a maximum of 3 years. The maximum lifetime number of sessions will be 45 total. Subsequent treatments will not be covered.
To be eligible for coverage, the medical record must document one of the following:
- Patient failed treatment with two anticholinergic drugs, each taken for at least 4 weeks duration, prior to the PTNS therapy initiation, or
- Patient demonstrates intolerance to anticholinergic drug therapy despite best attempts at management of the most common side effects, dry mouth and constipation.
|N39.498||Other specified urinary incontinence|
|R32||Unspecified urinary incontinence|
|R35.0||Frequency of micturition|
|R39.15||Urgency of urination|