`L8680` Implt neurostim elctr each

Implantable neurostimulator electrode, each

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Payer policies and prior authorization for L8680

52 of 52 payer prior-auth lists that name L8680 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, HealthSpring, Humana, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

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	Feb 18, 2013	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Feb 18, 2013	Master Precertification List (For Health Care Providers)
Cigna	Musculoskeletal (MSK) - Pain Management	All	prior auth required	Crossover code: MSK Pain Management / Sleep Management	Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Musculoskeletal (MSK) - Pain Management	All	prior auth required	Crossover code: MSK Pain Management / Sleep Management	Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Sleep Management
Cigna	Musculoskeletal (MSK) - Pain Management	All	prior auth required	Crossover code: MSK Pain Management / Sleep Management	Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Musculoskeletal (MSK) - Pain Management	All	prior auth required	Crossover code: MSK Pain Management / Sleep Management	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
Humana	Humana Healthy Horizons	IN	prior auth required		Jan 1, 2027	1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
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)
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth required		Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana Hoosier Care Connect	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana PathWays for Aging (MLTSS)	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth required		Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth required		Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Nebraska Heritage Health	NE	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth required		May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	Texas CHIP	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community Plan	Texas STAR	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community Plan	Texas STAR Kids	TX	prior auth required		Nov 1, 2016	Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community Plan	Texas STAR+PLUS	TX	prior auth required		Jan 1, 2015	Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Hawaii (QUEST Integration)	HI	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Virginia Cardinal Care LTSS	VA	prior auth required		Oct 1, 2026	Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026
UnitedHealthcare Community Plan	Virginia Cardinal Care Medicaid	VA	prior auth required		Oct 1, 2026	Prior authorization requirements for Virginia Cardinal Care Effective October 1, 2026
UnitedHealthcare Community Plan	Washington Apple Health	WA	prior auth required		Oct 1, 2026	Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth required		Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name L8680

L8680 appears in 166 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

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 (range L8680-L8683)	Aug 4, 2026	payer document
Aetna	Epilepsy Surgery (0394)	not covered	Jun 23, 2026	payer document
Aetna	Fecal Incontinence (0611) Acticon neosphincter	covered if criteria are met	Sep 23, 2026	payer document
Aetna	Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677)	covered if criteria are met	Sep 10, 2026	payer document
Aetna	Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (0678)	covered if criteria are met	Oct 7, 2025	payer document
Aetna	Headaches: Invasive Procedures (0707)	not covered	Jul 23, 2026	payer document
Aetna	Huntington's Disease (0614)	not covered (range L8680-L8683)	Sep 24, 2026	payer document
Aetna	Intraoperative Neurophysiological Monitoring (0697)	not covered (range L8679-L8689)	Jun 19, 2026	payer document
Aetna	Knee Arthroscopy / Osteoarthritis of the Knee (0673)	not covered	Feb 19, 2026	payer document
Aetna	Levator Syndrome Treatments (0679)	listed, no stance	Oct 15, 2025	payer document
Aetna	Motor Cortex Stimulation (0755)	not covered	Feb 24, 2026	payer document
Aetna	NeuroControl Freehand System (0378)	covered if criteria are met	May 26, 2026	payer document
Aetna	Obstructive Sleep Apnea in Adults (0004)	covered if criteria are met	Oct 6, 2026	payer document
Aetna	Obstructive Sleep Apnea in Children (0752)	covered if criteria are met	Oct 30, 2025	payer document
Aetna	Parkinson's Disease (0307)	not covered	Feb 24, 2026	payer document
Aetna	Peripheral Electrical Nerve Stimulation for Pain (0011)	covered if criteria are met	Jun 3, 2026	payer document
Aetna	Peripheral Electrical Nerve Stimulation for Pain (0011)	not covered	Jun 3, 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	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	Deep Brain Stimulation and Responsive Neurostimulation (SURG.00026)	covered if criteria are met	Aug 13, 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
Anthem	Gastric Electrical Stimulation (CG-SURG-70)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain (SURG.00158)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain (SURG.00158)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures) (SURG.00112)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence (CG-SURG-95)	covered if criteria are met	Aug 13, 2026	payer document
Anthem	Vagus Nerve Stimulation (CG-SURG-120)	covered if criteria are met	Feb 19, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Deep Brain Stimulation	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Responsive Neurostimulation For The Treatment Of Refractory Focal Epilepsy (A.7.01.143)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Sacral Nerve Neuromodulationstimulation	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Spinal Cord And Dorsal Root Ganglion Stimulation	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Vagus Nerve Stimulation	covered if criteria are met		payer document
Blue Shield of California	Cranial Electrotherapy Stimulation and Auricular Electrostimulation (8.01.58)	listed, no stance		payer document
Blue Shield of California	Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (7.01.143)	listed, no stance		payer document
Blue Shield of California	Spinal Cord and Dorsal Root Ganglion Stimulation (7.01.25)	listed, no stance		payer document
Blue Shield of California	\| Deep Brain Stimulation (7.01.63)	listed, no stance		payer document
Blue Shield of California	\| Gastric Electrical Stimulation (7.01.73)	listed, no stance		payer document
Blue Shield of California	\| Occipital Nerve Stimulation (7.01.125)	listed, no stance		payer document
Blue Shield of California	\| Vagus Nerve Stimulation (7.01.20)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation (CAM 80158) E0732 \| Cranial electrotherapy stimulation (ces) system, any type (eff 01/01/2024)	listed, no stance	Sep 1, 2026	payer document
BlueCross BlueShield of South Carolina	Deep Brain Stimulation (CAM 70163)	listed, no stance	Jun 1, 2026	payer document
BlueCross BlueShield of South Carolina	Gastric Electrical Stimulation (CAM 70173) 95982 \| ;subsequent, with reprogramming	listed, no stance	Oct 1, 2025	payer document
BlueCross BlueShield of South Carolina	Neuromuscular Electrical Stimulation (NMES) (CAM 014)	listed, no stance	Sep 1, 2026	payer document
BlueCross BlueShield of South Carolina	Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (CAM 701143) 61892 (effective 01/01/2024) \| Skull‐mounted cranial neurostimulator pulse generator or receiver removal	listed, no stance	Dec 1, 2025	payer document
BlueCross BlueShield of South Carolina	Sacral Nerve Neuromodulation/Stimulation (CAM 70169)	listed, no stance	Jun 1, 2026	payer document
Capital Blue Cross	Deep Brain Stimulation (MP 1.042)	covered if criteria are met	Jun 1, 2026	payer document
Capital Blue Cross	Gastric Electrical Stimulation (MP 2.069) Procedure codes	unproven / investigational	Jun 1, 2026	payer document
Capital Blue Cross	Occipital Nerve Stimulation (MP 2.372) Procedure Codes	unproven / investigational	Sep 1, 2026	payer document
Capital Blue Cross	Sacral Nerve Neuromodulation-Stimulation (MP 1.033) Procedure codes	covered if criteria are met	May 1, 2026	payer document
Centene	Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203)	covered if criteria are met	Jul 1, 2026	payer document
Centene	Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203)	not covered	Jul 1, 2026	payer document
Centene	Fecal Incontinence Treatments (CP.MP.137)	covered if criteria are met	May 1, 2026	payer document
Centene	Gastric Electrical Stimulation (CP.MP.40)	covered if criteria are met	Jan 1, 2026	payer document
Centene	Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180)	covered if criteria are met	Jan 1, 2026	payer document
Centene	Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Urinary Incontinence Devices and Treatments Reference Number: CP.MP.142 (CP.MP.142)	covered if criteria are met	Nov 1, 2025	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	Gastric Pacing/Gastric Electrical Stimulation (GES) (0103)	covered if criteria are met	Nov 15, 2025	payer document
Cigna	Headache, Occipital, and/or Trigeminal Neuralgia Treatment (0063)	not covered	Jun 15, 2026	payer document
Cigna	Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation (0539)	unproven / investigational	Mar 15, 2026	payer document
Cigna	Sacral Nerve Stimulation for Urinary Voiding Dysfunction, Fecal Incontinence and Constipation (0404)	covered if criteria are met	Nov 15, 2025	payer document
Cigna	Surgical Treatments for Obstructive Sleep Apnea (0158)	listed, no stance	Jun 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
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions (MED205.042) HCPCS Codes A4438, A4595, C1767, C1778, C1787, C1816, C1820, C1822, C1883,	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (SUR712.039) CPT Codes 61850, 61860, 61863, 61864, 61880, 61885, 61886, 61888, 61889,	listed, no stance	Dec 1, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Sleep Related Breathing Disorders: Surgical Management (SUR706.009) HCPCS Codes C1767, C1778, C8007, C8008, C8009, C8011, C8012, C8013, C9727,	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation (SUR712.009) HCPCS Codes C1767, C1778, C1787, C1816, C1820, C1822, C1826, C1883, C1897,	listed, no stance	Aug 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Vagus Nerve Stimulation (VNS) (SUR712.021)	listed, no stance	Aug 15, 2026	payer document
Premera Blue Cross	Deep Brain Stimulation (7.01.609)	listed, no stance	Sep 8, 2026	payer document
Premera Blue Cross	Gastric Electrical Stimulation (7.01.522)	listed, no stance	Apr 13, 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
Premera Blue Cross	Occipital Nerve Stimulation (7.01.125)	listed, no stance	Jun 8, 2026	payer document
Premera Blue Cross	Peripheral Subcutaneous Field Stimulation (7.01.139)	listed, no stance	Jun 22, 2026	payer document
Premera Blue Cross	Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (7.01.143)	listed, no stance	Oct 14, 2026	payer document
Premera Blue Cross	Sacral Nerve Neuromodulation/Stimulation (7.01.69)	listed, no stance	Jun 8, 2026	payer document
Premera Blue Cross	Spinal Cord and Dorsal Root Ganglion Stimulation (7.01.546)	listed, no stance	Jul 1, 2026	payer document
Premera Blue Cross	Vagus Nerve Stimulation (7.01.593)	listed, no stance	Mar 23, 2026	payer document
Regence	Deep Brain Stimulation (Surgery 84)	listed, no stance	May 1, 2026	payer document
Regence	Gastric Electrical Stimulation (Surgery 111) NOTES	listed, no stance	May 1, 2026	payer document
Regence	Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field Stimulation (Surgery 205)	listed, no stance	Jul 1, 2026	payer document
Regence	Occipital Nerve Stimulation (Surgery 174)	listed, no stance	Apr 1, 2026	payer document
Regence	Responsive Neurostimulation (Surgery 216)	listed, no stance	Jan 1, 2026	payer document
Regence	Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction (Surgery 134)	listed, no stance	Oct 1, 2025	payer document
Regence	Spinal Cord and Dorsal Root Ganglion Stimulation (Surgery 45)	listed, no stance	Mar 1, 2026	payer document
Regence	Vagus Nerve Stimulation (Surgery 74)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Deep Brain and Cortical Stimulation (CS030.T)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Deep Brain and Cortical Stimulation (2026T0321LL)	listed, no stance	Feb 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Mar 1, 2025: PA added, Rocky Mountain Health Plans
Mar 1, 2025: PA added, Rocky Mountain Health Plans
Nov 1, 2024: conditions changed, Oxford Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH, VA, WA.

AZ: $91.59 (outpatient_hospital), effective Oct 1, 2012
CO: $307.89 (chp_plus, non-facility), effective Jul 1, 2026
IN: $435.27 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $45.00 (asc), effective Jan 1, 2026
TX: $4889.90 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Mar 1, 2026
VT: $354.40 (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.

L8680 Implt neurostim elctr each