Humana Revises Medicare Advantage Policy Allowing PNS Treatment for Chronic Pain Under Certain Criteria

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.

While not perfect, this policy change, effective April 23, 2024, clarifies the criteria for PNS coverage under Medicare Advantage plans. We are cautiously optimistic that this revised policy marks a step towards ensuring access to innovative pain treatments for older adults.

This updated policy acknowledges that “While National Coverage Determination (NCD) 160.7 states that “[p]ayment may be made under the prosthetic device benefit for implantable peripheral nerve stimulators,” it does not provide additional guidance as to when the use of a peripheral nerve stimulator should be considered reasonable and necessary. For jurisdictions without an LCD, Humana determines medical necessity for a peripherally implanted nerve stimulator based on the criteria contained in LCD - Peripheral Nerve Stimulation (L37360) (cms.gov).”

Earlier this year, Humana's Medicare Advantage policy had excluded coverage for PNS, violating the rule that MA plans must follow CMS Medicare coverage policies. However, this revision indicates a significant shift towards allowing approvals for PNS., provided that healthcare providers and practices adhere to the criteria in the NCD (or the Noridian LCD for regions of that carrier).

We will continue to monitor how this policy change unfolds. We encourage you to share your experience with PNS payments from Humana directly with NANS ([email protected]). Your feedback will help us observe and understand the outcomes of this change.