Anthem Blue Cross and Blue Shield established favorable coverage for Mainstay Medical Holdings’ Reactiv8 restorative neurostimulation for intractable chronic low back pain.
Coverage went into effect on April 16, according to an April 28 news release. Under the policy Reactiv8 is considered medically necessary when clinical criteria are met, including a diagnosis of lumbar multifidus muscle dysfunction and patient selection criteria consistent with FDA approval guidelines and Mainstay’s clinical trial protocols.
The decision from the insurer builds on a 2023 statement from International Society for the Advancement of Spine Surgery advocating for restorative neurostimulation as a medically necessary treatment for mechanical chronic lower back pain, ISASS Past Co-President Morgan Lorio, MD, told Becker’s in a statement. ISASS was also involved in broader efforts to recognize lumbar multifidus dysfunction with a new ICD-10-CM code that took effect in October.
“This coverage decision is a testament to what happens when rigorous science, thoughtful advocacy, and patient need align,” Dr. Lorio said. “ISASS is proud to have helped advance the recognition of restorative neurostimulation as a medically necessary treatment for mechanical chronic low back pain. We believe therapies like ReActiv8 offer new hope for restoring function and improving lives.”
