Aetna Now Covers Peripheral Nerve Stimulation for Chronic Pain

In a policy published by Aetna last week, entitled Peripheral Electrical Nerve Stimulation for Pain Number: 0011, Aetna describes the coverage conditions for peripherally implanted nerve stimulators as follows:

Aetna considers peripherally implanted nerve stimulators (e.g., Curonix Freedom PNS System, Nalu PNS System, SPRINT PNS System, StimRouter System) medically necessary DME for treatment of members with intractable neuropathic pain when all the following criteria are met.

a. Member has chronic intractable pain, refractory to other methods of treatment (e.g., analgesics and other medications (including TCAs, SSRIs, SNRIs and antiseizure medications, where appropriate), physical therapy (in-person for at least 6 weeks in the past year), local injection, surgery); and

b. Member is not addicted to drugs (per American Society of Addiction Medicine guidelines); and

c. There is no psychological contraindication to peripheral nerve stimulation; and

d. There is objective evidence of pathology (e.g., electromyography/nerve conduction studies and diagnostic blocks of the specific affected nerve(s)); and

e. Trial of percutaneous stimulation was successful (resulting in at least a 50% reduction in pain for a minimum of 3 days). Note: If a peripheral nerve stimulation trial fails, a repeat trial is not medically necessary unless there are extenuating circumstances that lead to trial failure. Trials will be limited to four leads with maximum of 16 contacts.

You can access the updated policy here: Aetna Policy

As you all know, ASIPP has been focused and working on coverage of peripheral nerve stimulators. Enclosed, please see the letter sent to HCSC Policy Review on October 7, 2025.