Effective March 10, Aetna revised its Clinical Policy Bulletin to consider peripheral nerve stimulators medically necessary for the treatment of intractable pain when criteria are met, enabling eligible patients to receive coverage for PNS therapy.

Aetna covers approximately 4.4 million members nationwide, making this update a meaningful step in improving access to evidence-based neuromodulation care.

The medical policy is available to read online:

Developed by a multidisciplinary panel, the guideline provides a rigorous, evidence-based appraisal of the current literature on implantable PNS across chronic pain indications, including anatomical and indication-specific recommendations supported by graded levels of evidence.

As the clinical use of PNS continues to expand, the guideline aims to clarify where strong evidence exists, where emerging evidence may support clinical use, and where important research gaps remain.

As part of the guideline development process, NANS has opened a public comment period to allow stakeholders to review the draft recommendations. Submitted comments will be considered by the guideline development panel; however, feedback is advisory in nature, and NANS is not obligated to make revisions based on submitted comments.

The public comment period is open through March 31, 2026.
 
Review the draft recommendations and submit comments.

​The letters highlight a growing body of clinical evidence demonstrating that PNS is a safe and effective therapy for conditions such as chronic migraine, neuropathic pain, and complex regional pain syndrome.

The societies note that PNS devices are FDA-cleared and supported by Medicare coverage policies, yet some private payer policies continue to restrict access.
 
NANS and partner organizations are encouraging insurers to review the latest evidence and reconsider policies to ensure patients have access to this minimally invasive treatment option.

​NANS supports coverage of basivertebral nerve ablation (BVNA) and commends NGS for advancing access to this therapy for Medicare beneficiaries. In the letter, the societies recommend targeted refinements to ensure the policy reflects current evidence, supports appropriate patient selection, and avoids unintended barriers to care.
 
Key areas addressed include clarification around psychological screening requirements, flexibility in imaging interpretation and Modic change documentation, thoughtful application of imaging-based exclusion criteria, and updated considerations regarding osteoporosis and radicular pain exclusions.
 
This letter is part of NANS’ ongoing advocacy efforts to promote fair, evidence-based coverage policies that support both clinicians and patients.

Each Medicare MAC jurisdiction included in the WISeR model (Texas, New Jersey, Oklahoma, Ohio, Washington, and Arizona) has a different company providing the prior authorization services.

CMS pledged that portals for prior authorization will be operational by January 5, 2026.

​Below are links to the WISeR FAQ and WISeR provider guide. If you have any questions or challenges with the program, please let us know so we may consolidate and send concerns to the Agency.

CMS finalized updates to the CY2026 Medicare Physician Fee Schedule (PFS) that change how Medicare payments are calculated beginning January 1, 2026. Important updates include the following:  ​

2026 Conversion Factors  
For the first time in the history of the Medicare Physician Fee Schedule, CMS finalized two conversion factors. For 2026, CMS increased the conversion factors to $33.5675 for Qualifying Alternative Payment Model (APM) Participants (QPs) and $33.4009 for Nonqualifying APM Participants.

These represent increases of 3.77% and 3.26%, respectively, over the 2025 conversion factor. Many services may see a higher allowed amount due to a higher CF, though the new efficiency adjustment highlighted above may offset gains for some codes. 

New “Efficiency Adjustment” (work RVU/time impact)
CMS finalized an efficiency adjustment, which reflects a 2.5% decrease to the work RVUs and corresponding intraservice portion of physician time of non-time-based services. According to CMS, this adjustment reflects gains in practitioner experience, workflow improvement, and advances in technology that make certain procedures more efficient over time. In practice, this means that certain procedural services will see a downward adjustment in payment to reflect these efficiencies because the 2.5 percent cut to work RVUs and physician intraservice time impacts most specialties by reducing overall payment by one percent. 

Impact to Key Procedures
NANS has created a comprehensive Excel workbook with 2025 and 2026 Medicare physician payment (MPFS), Hospital Outpatient (OPPS) and ASC payments for Neuromodulation and Related Procedures APCS, Common Pain procedures and E/M and Telemedicine. To access the workbook, please log into your NANS eLearning account. The MPFS 2026 Tab in each workbook has the Non-Qualifying conversion factor included as the baseline. You can adjust it accordingly for your practice. 

New Category I CPT Codes
NANS participated with several physician specialty societies in the RUC process for two procedures that have new Category I CPT codes effective January 1, 2026. Thank you to all who participated in the surveys! 
64728 Median nerve at the carpal tunnel, percutaneous, with intracarpal tunnel balloon dilation, including ultrasound guidance
62330 Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; one interspace, lumbar 

• +62331 additional interspace(s), lumbar (List separately in addition to code for primary procedure) 

Telehealth Changes
The 2026 MPFS final rule permanently allows virtual direct supervision and lifts the frequency limits on providing subsequent hospital inpatient and nursing facility visits and critical care consultations furnished via telehealth. CMS will now permanently allow physicians to be immediately available via audio-video telecommunications for all services that require direct supervision except those with a 10- or 90-day global period. CMS has created a useful FAQ to highlight the changes, available here.

For additional information on the 2026 Medicare Physician Fee Schedule final rule, please see this summary.

Nearly one month after the MPFS CY 2026 Final Rule was released, CMS released the  CY 2026 Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center (“ASC”) the final rule. The Medicare fee schedule changes from both final rules are effective January 1, 2026. 

Key Takeaways from the CY2026 OPPS/ASC Final Rule
Elimination of the Inpatient Only List (“IPO”) was finalized and will be phased out over a 3-year period, beginning with the removal of 286 mostly musculoskeletal procedures for CY2026. The ASC Covered Procedures List (CPL) was also expanded and the criteria for inclusion on the list were loosened. Instead of CMS excluding many procedures categorically, CMS is putting more weight on physician judgment and patient selection. As a result of the criteria change and the IPO list being phased out, hundreds of procedures were added to the ASC CPL The complete list can be found in the ASC Addendum AA of the Hospital and ASC final rule.

Neurostimulator and Related Procedure APC Notable Changes
Despite a repeat request by many commenters, CMS maintained the current five level APC structure for Neurostimulator and Related Procedures (5164 – 5165). However, CMS did move and add several procedures to this family of APCs. Some highlights include: 

• CPT 61885 Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array and CPT 61891 Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s) were both reassigned from APC 5464 to APC 5465.
  • This represents an increase from $21,444 (2025) to $31,526 (2026) in the Medicare hospital outpatient setting.
  • In the ASC, the Medicare 2026 payment for 61885 of $27,985 is an increase of $7,882 over. 2025 There were a number of new CPT codes added to the Neurostimulator and Related Procedures APC family.

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• APC 1580: In recent years, three procedures that resided in APC 5465 Neurostimulator and Related Procedures were moved to APC 1580 New Technology - Level 43 ($40,001-$50,000). In the 2026 Hospital Outpatient final rule, CPT 64568 Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator was moved to APC 1580 from APC 5465.  
  • ​This change represents an increase to the hospital outpatient setting of care from $30,474 in 2025 to $45,001 in 2026.
  • In the ASC, the 2026 Medicare base rate is $42,373.

​​

• CPT 0908T Open implantation of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed status indicator was changed from an E1 status (not payable) to a J1 status due to receiving FDA approval in July. This is a new procedure to treat rheumatoid arthritis. It has been placed in APC 5465 which has a base payment of $31,526. In addition, CMS granted the technology transitional pass-through payment (TPT) and created a new device code to be reported in addition to the CPT code on Medicare claims: C1607 Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system

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• ​APC 5464 was negatively impacted by the reassignment of CPT 61885 and 61891 to APC 5465.  
  • The 2026 Medicare base rate for APC 5464 is $19,820, down from the 2025 base rate of $21,444. This impacts several procedures performed by NANS members, notably CPT 64590 Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver requiring pocket creation and connection between electrode array and pulse generator or receiver

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New Pain Procedure in the ASC
CPT 62330 Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; one interspace, lumbar and +62331 additional interspace(s), lumbar (List separately in addition to code for primary procedure) are effective January 1, 2026. The procedure has been assigned APC 5114 Level 4 Musculoskeletal Procedures, which has a 2026 Medicare base rate of $7,413 and an ASC rate of $4,682. 

• The codes have a status indicator of J1 Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the claim, except the Comprehensive APC payment policy exclusions found in the most recent Addendum J.

Under this policy, Anthem will cut hospital reimbursement by 10% whenever an out-of-network physician provides care at an in-network hospital and may even remove hospitals from its network for continued use of nonparticipating physicians.
 
As outlined in the joint letter, this policy:

• Circumvents the No Surprises Act, which already protects patients from unexpected bills
• Threatens independent physician practices by pressuring them into unfavorable contracts
• Reduces patient access, especially in rural and underserved areas that rely on a mix of participating and nonparticipating specialists

 
For neuromodulation providers, the policy could disrupt care coordination, limit procedural access, and undermine practice autonomy.
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NANS remains committed to advocating for fair contracting, sustainable practice environments, and patient access to high-quality neuromodulation care.