Implanted Spinal Neurostimulators: Document Medical Records

In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor (MAC) to authorize these services before performing the procedure in the hospital outpatient department.

Learn what you need to include in patient medical records to support Medicare coverage:

• Hospital Outpatient Department (OPD) Services webpage
• Hospital Outpatient Prospective Payment System Final Rule Section XVII
• Implanted Spinal Neurostimulators: OPD Guide (PDF) Section 6.3.2.2
• 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)