Implantable infusion pumps are considered medically necessary when used to deliver drugs having U. Food and Drug Administration approval for this route of access and for the related indication for the treatment of:
· Severe, chronic, intractable pain (intravenous, intrathecal, and epidural injection of opioids), after a successful temporary trial of opioid or nonopioid analgesics by the same route of administration as the planned treatment. A successful trial is defined as greater than 50% reduction in pain after implementation of treatment; and
· Severe spasticity of cerebral or spinal cord origin in patients who are unresponsive to or who cannot tolerate oral baclofen therapy (intrathecal injection of baclofen).
Implantable infusion pumps are considered investigational for all other uses related to pain and spasticity.
