Reimbursement

Nevro’s patient access program, HFX Access™, is available to assist patients in navigating the prior authorization process for HFX SCS Therapy. Access can support your patients’ pathway to approval including:

Prior Authorization
Pre-Determination
Denial Support through the internal and external appeal process
Billing/Coding/Coverage questions

Patient Authorization Form for Release of Information – English

PDF

Patient Authorization Form for Release of Information – Spanish

PDF

Coverage

HFX SCS Therapy is covered by nearly all major insurance plans, including Medicare, as a late or last resort therapy for chronic intractable back and leg pain. Payers continue to add painful diabetic neuropathy (PDN) as a covered indication for HFX SCS therapy based upon Nevro’s published level one Randomized Controlled Trial (RCT) evidence for PDN.

Most payers require prior authorization for SCS to show that the patient is refractory to conventional medical management (CMM). Nevro’s Market Access team can provide up-to-date spinal cord stimulation coverage policies for any insurance plan. These policies highlight the covered indications and specific documentation requirements. Please reach out to Market.Access@nevro.com for details.

Reimbursement Guide

This Reimbursement Guide is an interactive PDF covering the common questions and barriers of reimbursement including the following sections:

Coverage – Includes a Medicare Coverage Map and details on requirements of psychological evaluations and surgical consultations
Coding – Organized lists of CPT, ICD-10-CM, and relevant HCPCS codes
Payment – Medicare National average reimbursement amounts
Patient Access – Overview of HFX Access including how to utilize this service and background on important documents