L8684 Radiof trsmtr implt scrl neuRadiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
7 of 7 payer prior-auth lists that name L8684 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Humana, Rocky Mountain Health Plans.
| 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) | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 | |
| Blue Cross and Blue Shield of New Mexico | Turquoise Care (New Mexico Medicaid) | NM | prior auth required | Oct 1, 2026 | New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26 | |
| Humana | Humana Healthy Horizons | OK | prior auth required | Jan 1, 2027 | Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| 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 |
L8684 appears in 18 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Capital Blue Cross, Centene, Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | covered if criteria are met | Feb 24, 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 | Intraoperative Neurophysiological Monitoring (0697) | not covered (range L8679-L8689) | Jun 19, 2026 | payer document |
| Aetna | Levator Syndrome Treatments (0679) | not covered | Oct 15, 2025 | payer document |
| Aetna | Parkinson's Disease (0307) | not covered | Feb 24, 2026 | payer document |
| Aetna | Spinal Cord Stimulation (0194) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | 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 |
| Blue Cross & Blue Shield of Mississippi | Sacral Nerve Neuromodulationstimulation | covered if criteria are met | payer document | |
| Blue Shield of California | | Occipital Nerve Stimulation (7.01.125) | listed, no stance | 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 | Fecal Incontinence Treatments (CP.MP.137) | covered if criteria are met | May 1, 2026 | 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 |
| Premera Blue Cross | Sacral Nerve Neuromodulation/Stimulation (7.01.69) | listed, no stance | Jun 8, 2026 | payer document |
| Premera Blue Cross | Vagus Nerve Stimulation (7.01.593) Page | 7 of 30 | ∞ | listed, no stance | Mar 23, 2026 | payer document |
| Regence | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction (Surgery 134) | listed, no stance | Oct 1, 2025 | payer document |
Prior authorization required or conditional in CO, IL, IN, NE, OH, VA.
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.