The American Society of Pain and Neuroscience (ASPN) Evidence-Based Consensus Recommendations on Programming and Coding Implantable Spinal Cord Stimulation Devices for Treatment of Chronic Intractable Pain

Background: The evolution of Spinal Cord Stimulation (SCS) from simple bipolar programming to sophisticated physiologic closed-loop technology has introduced significant complexity into programming and associated reimbursement coding and billing. To address these challenges, the American Society for Pain and Neuroscience (ASPN) developed this evidence-based consensus document to establish best practices for integrating advanced SCS programming into clinical workflows. Materials and Methods: A US-based expert panel in neuromodulation convened to develop consensus recommendations for traditional and modern complex programming. No international experts in neuromodulation participated in this exercise. This process informed the development of a framework that combines technological advances with improved clinical decision-making and creation of customized care plans for chronic pain patients. Results: Complex programming is defined as the adjustment of more than three stimulation parameters. However, innovations like Evoked Compound Action Potential (ECAP) dose-controlled closed-loop SCS technology provide objective neurophysiological data requiring additional physician engagement and clinical decision-making in the programming process. Objective data provide additional documentation, and when combined with traditional subjective data it ensures that clinical decisions are evidence-based and well-documented in patients’ medical history. This article reviews Current Procedural Terminology (CPT) codes and billing processes, offering clear recommendations on billing for complex programming. The framework aims to ensure that reimbursement models accurately reflect the time, resources, and expertise required for modern SCS programming while complying with coding and billing regulations. Conclusion: Current billing and reimbursement structures must be refined to recognize the additional diagnostic and therapeutic value provided by ECAP dose-controlled closed-loop therapy neural metrics. The incorporation of ECAP dose-controlled closed-loop SCS technology into routine clinical care has the potential to improve patient outcomes through comprehensive physician-led programming. This in turn will reduce the burden of chronic pain on the healthcare system by minimizing unnecessary reprogramming and emergency room visits. Keywords: spinal cord stimulation, chronic pain, SCS programming, closed-loop, ECAP