Reimbursement
Reimbursement
SPR has an experienced team of Patient Access Specialists available to help navigate the reimbursement landscape, including the coverage of peripheral nerve stimulation (PNS).
SPRcare® Patient Access Program
The SPRcare Patient Access Program provides two levels of support:
1. General support: The team is available to provide answers to coding, coverage, and payment questions. To connect with an experienced reimbursement team member, please email [email protected].
2. Patient access support: An experienced team of Patient Access Specialists is available to facilitate insurance verifications, prior authorizations, and appeals to support healthcare professionals and patients in obtaining prior approval for the SPRINT® PNS System. This program also provides direct patient support and advocacy throughout the appeals process. Connecting with a Patient Access Specialist is easy: simply email [email protected] or call an SPRcare Patient Access Specialist at (833) 777-2884.
Coding and reimbursement reference guides
Coverage
Many payers provide coverage for the SPRINT PNS System, however, it can be dependent on the patient's insurance plan type and specific health plan.
- Traditional Medicare is outlined in NCD 160.7 (Electrical Stimulators, 160.7, section A). All Medicare Administrative Contractors (MACs) follow this policy, except Noridian, which maintains its own Local Coverage Determination (LCD) with specific criteria.
- Medicare Advantage plans, although administered by private insurers, generally follow the same coverage criteria established under Traditional Medicare.
- Coverage under commercial insurance plans varies based on each payer's specific medical policy.
The SPRINT® 60-day PNS System was also recognized by Centers for Medicare and Medicare Services (CMS) in the 2025 Final Rule as meeting the requirements for coverage outlined in the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act. This distinction was reaffirmed in the 2026 Final Rule. Please reach out to the SPR Reimbursement Team for more information about payer policies and the NOPAIN Act.
Advocacy
SPR collaborates with healthcare professionals and professional societies to advocate for better coverage and improvements in complex medical policies. If you are interested in advocating for better access to PNS for your patients, please contact the Market Access team by email at [email protected]
Helpful FAQs
Is SPRINT covered by insurance?
While many insurance companies do cover the SPRINT PNS system, there may be instances where it is not initially approved. In such cases, the SPRcare Patient Access Program is here to support you and your office. By leveraging SPRcare’s resources and expertise, many offices have successfully obtained coverage for their patients.
If our office is not able to register with SPRcare, can we still receive support?
Yes, our team of experts is available to provide reimbursement support including answering questions around coding, coverage and payment. Additionally, SPRcare can provide direct support to your patients in requesting an appeal if a denial is received.
Disclaimer: Coverage is based on patient eligibility, specific plan benefits, medical necessity, individual contracts, and local coverage policies. Verification of benefits and/or prior authorization approval are not a guarantee of payment. Providers must submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper place of service, and to submit appropriate codes, charges, and modifiers for services rendered. SPR does not promote the use of SPRINT PNS outside of the FDA-labeled indications. The SPRcare Program cannot support patient cases which fall outside of the FDA-labeled indications for treatment. Please refer to the SPRINT PNS System’s instructions for use (IFU) for labeled indications. By participating in the SPRcare program, you are acknowledging your awareness of the above statements.