D-SNP Medical Coverage Policy: Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation

In February 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) implemented an updated Medicare Part C Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation policy for all Blue Medicare HMO^℠, Blue Medicare PPO^℠, Healthy Blue + Medicare^℠ (HMO-POS D-SNP), Blue Medicare Rx^℠ members, and members of any third-party Medicare plans supported by Blue Cross NC through administrative or operational services.

Effective January 1, 2026, this policy also applies to Dual Eligible Special Needs Plan (D-SNP) members.

Blue Cross NC is noticing this policy to comply with CMS mandates regarding the Plan implementing internal Medical Policies in the absence of National Coverage Determinations (NCD) or Local Coverage Determinations (LCD) coverage criteria.

Blue Cross NC will provide coverage for Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation services when it is deemed medically necessary in accordance with best practice standards, which are detailed within the policy. Please see the full policy, Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation, for more information.