CSHCN 2009 > Neurostimulator Devices and Supplies > Benefits, Limitations, and Authorization Requirements

25.2 Benefits, Limitations, and Authorization Requirements

Neurostimulator procedures and the rental or purchase of devices and associated supplies, such as leads and form fitting garments, are a benefit of the CSHCN Services Program when medically necessary.

For percutaneous electrical nerve stimulation (PENS), intracranial neurostimulation (ICN), dorsal column neurostimulation (DCN), vagal nerve stimulation (VNS), and sacral nerve stimulation (SNS), providers may request prior authorization for clients without one of the covered diagnoses listed for that device. The provider must submit documentation of medical necessity with the request which will be reviewed by the DSHS-CSHCN Medical Director or a designee.

Providers must request prior authorization in writing with supporting documentation or submit the Appendix B, "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)".

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.