Diabetic peripheral neuropathy is a covered condition by Medicare and many other insurers however, Cigna has incorporated into the new policy effective August 4, 2026 to cover diabetic peripheral neuropathy when all the criteria are met as follows:
Trial
A short-term trial (i.e., at least [5] days) of a non-high-frequency or high-frequency (HF10 SCS) dorsal column spinal cord stimulator is considered medically necessary when ALL of the following criteria have been met:
- Performed for the treatment of chronic, intractable pain secondary to diabetic peripheral neuropathy in the lower extremities
- Symptoms include BOTH of the following:
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- lower extremity neuropathic pain present for >12 months
- pain is rated at least VAS ≥5
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- Ineffective pain relief with or intolerance to at least TWO of the following:
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- anticonvulsants
- tricyclic antidepressant
- SNRI (serotonin-norepinephrine reuptake inhibitor)
- opioids
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- If taking opioids, the opioid use is ≤100MME (morphine milligram equivalent) per day.
- Hemoglobin A1c (HbA1c) <10% within three (3) months prior to trial
- There are no other medical diagnoses (e.g. chronic inflammatory demyelinating polyneuropathy [CIDP]; Hepatitis B; HIV; Lyme disease; chemotherapy or vitamin deficiency induced neuropathy) that are concordant with the presenting symptoms, signs, and results of relevant studies (e.g., imaging, electrodiagnostic testing, laboratory testing, etc.).
- Attestation by a behavioral health provider (i.e., a face-to-face or virtual assessment [with or without psychological questionnaires and/or psychological testing]) reveals no evidence of inadequately controlled mental and/or behavioral health conditions/issues (e.g., substance use disorders, depression, or psychosis) that would impact perception of pain, and/or negatively impact the success of a SCS or contraindicate placement of the device
Permanent Implant
Permanent implantation of a non-high-frequency or high-frequency (HF10 SCS) dorsal column spinal cord stimulator is considered medically necessary when BOTH of the following criteria have been met:
- Must meet ALL criteria for a short-term trial spinal cord stimulator as noted above.
- There has been documented pain relief of at least 50% during a short-term trial of SCS.