{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:01Z","timestamp":1787030701420,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sacral nerve stimulation (SNS) is an established therapy for refractory urinary incontinence, yet the 2025 Wasteful and Inappropriate Service Reduction Model (WISeR) designated it as requiring mandatory prior authorization. No analysis has examined how U.S. payers translate SNS evidence into coverage policies or whether restrictions are evidence\u2010based. We sought to: (1) compare covered and excluded indications, (2) evaluate restriction criteria and conservative therapy requirements, and (3) assess quality of evidence cited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a systematic, retrospective analysis of publicly available SNS coverage policies. Independent reviewers extracted data from 11 major U.S. payers, including Medicare. Data included indications, contraindications, implantation criteria, and cited references. References were classified using Oxford Centre for Evidence\u2010Based Medicine hierarchy into Levels I\u2013V or \u201cOther\u201d (guidelines, technology assessments, regulatory documents).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All payers covered core urinary indications, while 63.6% excluded neurologic disease. All required conservative therapy failure for trial, but specificity varied from specific drug combinations to voiding diaries. All required symptomatic improvement for permanent implantation; 90.9% specified &gt;\u200950% improvement. References ranged from\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200915\u2013112 per policy. While 90.9% cited Level I evidence, proportions ranged from 0% to 31.6%. Five payers had &gt;\u200950% of references classified as \u201cOther;\u201d only Medicare had majority primary evidence (89.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>While payers agree on core urinary indications, coverage for neurologic conditions is inconsistently defined. Because FDA labeling does not endorse SNS for neurologic etiologies such as spinal cord injury, variable exclusions are understandable yet create confusion for clinicians navigating prior authorization. Wide variation in therapy and documentation requirements highlights lack of transparency as WISeR expands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70366","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:42:13Z","timestamp":1783323733000},"page":"1280-1293","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prior Authorization for Sacral Nerve Stimulation in the Era of WISeR: Evaluation of U.S. Payer Coverage Policies"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0586-1343","authenticated-orcid":false,"given":"Thriaksh","family":"Rajan","sequence":"first","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Revnew","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sheyn","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"},{"name":"University Hospitals Ahuja Medical Center Beachwood Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adonis","family":"Hijaz","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"},{"name":"University Hospitals Ahuja Medical Center Beachwood Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramy","family":"Abou Ghayda","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland Ohio USA"},{"name":"University Hospitals Ahuja Medical Center Beachwood Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"WISeR (Wasteful and Inappropriate Service Reduction) Model | CMS. accessed September 29 2025.https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/wiser."},{"key":"e_1_2_11_3_1","article-title":"Ohio Medicare Is Part of New AI Prior Authorization Program","author":"Hack C.","year":"2025","journal-title":"Signal Cleveland"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01375"},{"key":"e_1_2_11_5_1","unstructured":"Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services. October 1 2021. accessed October 5 2025.https:\/\/oig.hhs.gov\/reports\/all\/2021\/medicare-overpaid-636-million-for-neurostimulator-implantation-surgeries\/."},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.11043"},{"key":"e_1_2_11_7_1","volume-title":"In: StatPearls","author":"Leslie S. W.","year":"2025"},{"issue":"1","key":"e_1_2_11_8_1","first-page":"43","article-title":"Sacral Nerve Stimulation for the Management of Voiding Dysfunction","volume":"2","author":"Das A. K.","year":"2000","journal-title":"Reviews in Urology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2510451"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cont.2024.101328"},{"key":"e_1_2_11_11_1","article-title":"FDA Expands MRI Labeling for InterStim SNM Bladder and Bowel Control Devices","author":"Broderick J. M.","year":"2021","journal-title":"Urology Times"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.23515"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000003985"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/24730114241239310"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2016.22.10.1176"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/jbcr\/iraf133"},{"key":"e_1_2_11_17_1","unstructured":"AMA identifies market leaders in health insurance. American Medical Association. December 12 2023. accessed September 29 2025.https:\/\/www.ama-assn.org\/press-center\/ama-press-releases\/ama-identifies-market-leaders-health-insurance."},{"key":"e_1_2_11_18_1","unstructured":"Explanation of the 2011 OCEBM Levels of Evidence. accessed September 29 2025.https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/explanation-of-the-2011-ocebm-levels-of-evidence."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_11_20_1","unstructured":"Center for Medicare and Medicaid Innovation Announces Prior Authorization Demonstration for Original Medicare. American Speech\u2010Language\u2010Hearing Association. accessed September 29 2025.https:\/\/www.asha.org\/news\/2025\/center-for-medicare-and-medicaid-innovation-announces-prior-authorization-demonstration-for-original-medicare\/?srsltid=AfmBOootdqtWysu8SlQxRWiRlohqqbcaRaJCHAQB9HAnTeH0pvCcQKGe."},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.12194"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/CU9.0000000000000201"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-025-01280-6"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.20907"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.5152\/tud.2018.94041"},{"key":"e_1_2_11_26_1","unstructured":"C. A.Grimm. High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care."},{"issue":"9","key":"e_1_2_11_27_1","first-page":"634","article-title":"Clinical Management of Urinary Incontinence in Women","volume":"87","author":"Hersh L.","year":"2013","journal-title":"American Family Physician"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cont.2024.101697"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0090-4295(00)00597-5"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25374"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102841"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2011.000300"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7182.527"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-022-01229-4"}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70366","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/nau.70366","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70366","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:24:17Z","timestamp":1787027057000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.70366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/nau.70366"],"URL":"https:\/\/doi.org\/10.1002\/nau.70366","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"assertion":[{"value":"2025-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}