In March, we learned about Cigna’s Medical Coverage Policy, characterizing peripheral nerve stimulation (PNS) to treat chronic pain as “not medically necessary.” On behalf of 88,000 physician members in national medical societies, NANS leads the response [PDF letter] objecting to CIGNA’s depiction of the treatment as lacking medical necessity.
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NANS signs on to support the introduction of the Seniors’ Act or the Improving Seniors’ Timely Access to Care Act, a bipartisan legislation to streamline the use of prior authorizations (PA) under Medicare Advantage (MA) allowing seniors to get timely care and helping reduce administrative burden for health care providers.
On behalf of the 40,000+ members across 10 medical societies, NANS submitted a response (PDF) to draft guidelines for SCS coverage proposed by the Washington State Health Technology Clinical Committee. This historic shift in coverage means that, for the first time ever, patients covered by state insurance will have access to SCS treatment for failed back surgery syndrome (FBSS), nonsurgical refractory back pain (NSRBP) and painful diabetic neuropathy (PDN). This change was only possible due to the tireless advocacy of Washington-based physicians and national medical societies.
NANS Supports Protections for Thousands of Medical Providers in Change Healthcare Cyberattacks5/29/2024 In February, Change Healthcare, the nation’s largest processor of medical claims, experienced one of the largest cyberattacks in the healthcare industry. This resulted in the loss of patient and claims data. This breach continues to have significant financial and operating impacts on medical providers across the country.
On May 17, in a follow-up meeting with the Washington State Health Technology Clinical Committee (HTCC), members voted to cover spinal cord stimulation (SCS) for patients with nonsurgical low back pain, diabetic peripheral neuropathy and failed back surgery syndrome. For more than 12 years, patients suffering from these conditions were denied access to SCS.
In March, we alerted you Humana’s exclusion of PNS for the treatment of chronic pain in their Medicare Advantage policy. NANS issued a statement on behalf of 12 medical societies through the Multisociety Pain Workgroup.
We recently learned that Humana has revised its Medicare Advantage policy (#HUM-114-001) regarding coverage of PNS for chronic pain. In March, CIGNA released policy 0539, characterizing peripheral nerve stimulation (PNS) as “not medically necessary.” NANS is currently working with the PNS Subcommittee to respond to this categorization.
NANS joins the Multisociety Pain Workgroup to object to Palmetto’s draft local coverage determination (LCD DL39797) for minimally invasive arthrodesis of the sacroiliac joint. Palmetto is Medicare Administrative Contractor (MAC) with jurisdiction over several states in the Southeast U.S.
In December, NANS led efforts on behalf of the Multisociety Pain Workgroup (MPW) to object to the insurers’ classification of closed-loop spinal cord stimulation (SCS) as “experimental, investigational and/or unproven.” Thanks to these efforts, Cigna and EviCore (and includes several Blue Cross Blue Shield plans) have revised their policies to include coverage of closed-loop SCS. These revised policies become effective May 1, 2024.
In January 2024, Humana issued Medicare Advantage policy HUM-1140-000 [PDF], excluding from coverage peripheral nerve stimulators (PNS) for treating chronic pain. This policy contradicts Medicare's longstanding practice of covering and paying for the reasonable and necessary use of PNS for chronic pain management and appears inconsistent with the Noridian Local Coverage Decision and the CMS National Coverage Decision (NCD 160.7). Working with the Multi-Society Pain Workgroup, NANS issued a statement [PDF] on behalf of 12 medical societies to Humana and CMS administrators objecting to the policy.
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June 2024
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