Blue Cross Shield denies coverage for high-frequency spinal cord stimulation in two US states


Blue Cross Blue Shield has denied coverage for high frequency [10,000 (HF-10)] spinal cord stimulation in at least two states. Outposts of the federation of health insurance organisations in Tennessee and Pennsylvania (both USA) consider HF-10 spinal cord stimulation to be experimental and investigational for the treatment of leg and back pain.

According to an American Society of Regional Anesthesia and Pain Medicine press release, this therapy demonstrates clinical effectiveness. The society  welcomes the treatment as an alternative to opioid painkillers.


“This modality is precisely the sort of treatment that the Centers for Disease Control Guideline would seem to recommend in light of the opioid crisis in America,” says David Provenzano, president of Pain Diagnostics and Interventional Care in Sewickley, USA.

ASRA leadership has written letters to both Blue Cross Blue Shield of Tennessee and Highmark Blue Cross Blue Shield of Pennsylvania, raising critical concerns about the classification decision.

The Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain urges physicians to find nonopioid therapies for patients experiencing chronic pain. One such therapy is HF-10, Provenzano argues. The ASRA release cites a randomised clinical trial published in 2015 by Leonardo Kapural and colleagues, showing significant improvement in 67% of patients treated by HF-10 spinal cord stimulation. By comparison, the release notes, studies of patients receiving pharmacologic therapy have demonstrated less than 50% to experience significant improvement (Dworkin et al, 2003).

The Kapural study was used to support the US Food and Drug Administration’s original approval of HF-10. The work also recently received the highest quality score in a systematic review and methodological assessment of SCS therapies by Grider et al, (2015).