Newly approved Recovery Auditor issues - 10/12/2015

Performant Recovery posted two new issues to its CMS list for providers in Region A. (See link for individual state applicability.)

According to the Performant website, the new issues are:

For Outpatient:

• Sacral Nerve Stimulation for Urinary Incontinence - JK. National Coverage Determination (NCD) 230.18 (Sacral Nerve Stimulation for Urinary Incontinence) includes specific coverage criteria, including noncoverage for stress incontinence, urinary obstruction and specific neurologic diseases that manifest as urinary incontinence; and limitations to coverage, including that the patient must be refractory to conventional therapy and must have had a successful test stimulation prior to implant.
• Sacral Nerve Stimulation for Urinary and Fecal Incontinence – JL. National Coverage Determination (NCD) 230.18 (Sacral Nerve Stimulation for Urinary Incontinence) includes specific coverage criteria, including noncoverage for stress incontinence, urinary obstruction and specific neurologic diseases that manifest as urinary incontinence; and limitations to coverage, including that the patient must be refractory to conventional therapy and must have had a successful test stimulation prior to implant. Novitas LCDs for Sacral Nerve Stimulation clarify urinary incontinence medical necessity requirements and also include medical necessity criteria for sacral nerve stimulation used to treat fecal incontinence.