`C1816` Receiver/transmitter, neuro

Receiver and/or transmitter, neurostimulator (implantable)

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 2 units per day (clinical), rationale: Clinical: CMS Workgroup
Outpatient hospital: max 2 units per day (clinical), rationale: Clinical: Data

Payer policies and prior authorization for C1816

23 of 23 payer prior-auth lists that name C1816 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), CarePlus Health Plans, Cigna, HealthSpring, Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth required		Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required		Sep 1, 2026	AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	State of Arizona employee group (SYD, S3Z)	AZ	prior auth required		Sep 1, 2026	State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Jan 1, 2016	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Jan 1, 2016	Master Precertification List (For Health Care Providers)
Cigna	Musculoskeletal	All	prior auth required		Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Musculoskeletal	All	prior auth required		Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Interventional Pain Management
HealthSpring	Medicare Advantage	All	prior auth required		Jan 1, 2025	2026 Q4 Prior Authorization List
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth required		Jan 1, 2027	1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
Humana	Humana D-SNP (SC)	SC	prior auth required		Jan 1, 2027	Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	KY	prior auth required		Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana Puerto Rico MA and Dual Medicare-Medicaid	PR	prior auth required		Nov 3, 2025	Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name C1816

C1816 appears in 28 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Centene, Cigna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Acute Ischemic Stroke Treatments (0789) Cerebrolysin, Transdermal glyceryl trinitrate, Statins (e.g. simvastatin)	not covered	Nov 19, 2025	payer document
Aetna	Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (0788)	not covered	Nov 19, 2025	payer document
Aetna	Complex Regional Pain Syndrome (CRPS): Treatments (0447)	covered if criteria are met	Jul 16, 2026	payer document
Aetna	Deep Brain Stimulation (0208)	covered if criteria are met	Mar 27, 2026	payer document
Aetna	Diabetic Neuropathy: Selected Treatments (0729)	covered if criteria are met	Feb 24, 2026	payer document
Aetna	Eating Disorders (0511)	not covered	Aug 4, 2026	payer document
Aetna	Fecal Incontinence (0611) Acticon neosphincter	covered if criteria are met	Sep 23, 2026	payer document
Aetna	Headaches: Invasive Procedures (0707)	not covered	Jul 23, 2026	payer document
Aetna	Huntington's Disease (0614)	not covered	Sep 24, 2026	payer document
Aetna	Motor Cortex Stimulation (0755)	not covered	Feb 24, 2026	payer document
Aetna	Parkinson's Disease (0307)	not covered	Feb 24, 2026	payer document
Aetna	Spasticity Management (0362)	not covered	May 26, 2026	payer document
Aetna	Spinal Cord Stimulation (0194)	covered if criteria are met	Sep 10, 2026	payer document
Aetna	Tinnitus Treatments (0406)	not covered	Jul 10, 2026	payer document
Aetna	Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine	not covered	Jun 29, 2026	payer document
Aetna	Urinary Incontinence (0223)	covered if criteria are met	Jul 16, 2026	payer document
Aetna	Vagus Nerve Stimulation (0191)	covered if criteria are met	Mar 31, 2026	payer document
Aetna	Vocal Cord Paralysis / Insufficiency Treatments (0253) HCPCS not covered for indications listed in the CPB [posterior cricoarytenoideus re-innervation and pacing]	not covered	Apr 15, 2026	payer document
Anthem	Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems (CG-MED-79)	covered if criteria are met	Nov 6, 2025	payer document
Blue Cross & Blue Shield of Mississippi	Implantable Peripheral Nerve Stimulation For Chronic Pain Conditions	unproven / investigational		payer document
Blue Shield of California	Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions (1.01.31)	listed, no stance		payer document
Centene	Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203)	covered if criteria are met	Jul 1, 2026	payer document
Centene	Vagus Nerve Stimulation (CP.MP.12)	covered if criteria are met	Jul 1, 2026	payer document
Cigna	Deep Brain, Motor Cortex and Responsive Cortical Stimulation (0184)	covered if criteria are met	Nov 15, 2025	payer document
Cigna	Deep Brain, Motor Cortex and Responsive Cortical Stimulation (0184)	unproven / investigational	Nov 15, 2025	payer document
Cigna	Diaphragmatic/Phrenic Nerve Stimulation (0391)	covered if criteria are met	Jul 15, 2026	payer document
Cigna	Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation (0539)	unproven / investigational	Mar 15, 2026	payer document
Cigna	Vagus Nerve Stimulation (VNS) (0350)	covered if criteria are met	Feb 15, 2026	payer document
Cigna	Vagus Nerve Stimulation (VNS) (0350)	not covered	Feb 15, 2026	payer document
Premera Blue Cross	Implantable Peripheral Nerve Stimulation for the Treatment of Chronic Pain and Other Conditions (7.01.574)	listed, no stance	Jul 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2026: PA added, HealthSpring

Medicaid fee-for-service

Prior authorization required or conditional in IN.

KY: $0.00 (asc), effective Jan 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

C1816 Receiver/transmitter, neuro