Medicare Contractor Issues Favorable Coverage Policy

Parrish Law Offices has successfully challenged a non-coverage policy on behalf of two Medicare beneficiaries, resulting in a favorable coverage policy on behalf of all Medicare beneficiaries in the relevant jurisdiction.

Specifically, Parrish Law Offices filed challenges to Wisconsin Physicians Services’ non-coverage local coverage determination (“LCD”) on posterior tibial nerve stimulation (“PTNS”). PTNS is a treatment for incontinence. Each of the Medicare beneficiaries’ treating physicians believed that PTNS was reasonable and medically necessary for their patients and submitted statements in support of the beneficiary challenges.

Although PTNS is covered and is widely used in most of the rest of the country, WPS did not concede the impact of its negative LCD and argued that only a few physicians in its jurisdiction offered the treatment. WPS defended its non-coverage as recently as late April, despite the existence of numerous peer-reviewed, academic and scientific articles.

WPS covers approximately 8.7 million Medicare beneficiaries. WPS posted a revised LCD indicating that it would begin covering PTNS effective June 1, 2013. The new policy may be found at


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