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Responsive Cortical Stimulation, Responsive cortical stimulation e g NeuroPace RNS System is proven and medically necessary for. treating Partial Onset Seizures when used according to U S Food and Drug Administration FDA labeled. indications contraindications warnings and precautions. Responsive cortical stimulation is unproven and not medically necessary for treating conditions in. individuals who do not meet the above criteria due to insufficient evidence of efficacy. DOCUMENTATION REQUIREMENTS, Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws. that may require coverage for a specific service The documentation requirements outlined below are used to assess. whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. CPT HCPCS Codes Required Clinical Information, Deep Brain and Cortical Stimulation. For stimulation used for idiopathic Parkinson s disease essential tremor and primary. 61863 dystonia medical notes documenting all of the following. 61864 Specify specific procedure e g thalamic VIM STN or GPI deep brain. 61867 stimulation, 61868 Physician office notes that include. 61885 o Symptoms, 61886 o Co morbidities, o Previous movement disorder surgery within the affected basal ganglion.
For Thalamic VIM include Fahn Tolosa Marin Clinical Tremor Rating Scale or. L8682 equivalent scale, L8685 For STN or GPI include. L8686 o Hoehn and Yahr stage or Unified Parkinson s Disease Rating Scale part III. L8687 motor subscale, L8688 o L dopa responsiveness. o Persistent disabling Parkinson symptoms despite optimal medical therapy. For code descriptions see the Applicable Codes section. DEFINITIONS, Generalized Seizures Seizures engaging networks across both cerebral hemispheres Epilepsy Foundation 2017. Partial Seizures Partial Onset Seizures or Focal Onset Seizures Seizures originating within networks limited. to one cerebral hemisphere Epilepsy Foundation 2017. Primary Dystonia A movement disorder in which dystonia is the only symptom and there is no known acquired. cause of the dystonia Primary Dystonia may occur for unknown reasons or may be inherited Phukan et al 2011. American Association of Neurological Surgeons 2018. Secondary Dystonia Secondary Dystonia occurs with illness after trauma or following exposure to certain. medications or toxins Phukan et al 2011, Secondary Parkinsonism Secondary Parkinsonism occurs as a result of head trauma metabolic conditions toxicity. drugs or other medical disorders, APPLICABLE CODES.
The following list s of procedure and or diagnosis codes is provided for reference purposes only and may not be all. inclusive Listing of a code in this policy does not imply that the service described by the code is a covered or non. covered health service Benefit coverage for health services is determined by the member specific benefit plan. document and applicable laws that may require coverage for a specific service The inclusion of a code does not imply. any right to reimbursement or guarantee claim payment Other Policies and Coverage Determination Guidelines may. CPT Code Description, 61850 Twist drill or burr hole s for implantation of neurostimulator electrodes cortical. Deep Brain and Cortical Stimulation Page 2 of 19, UnitedHealthcare Commercial Medical Policy Effective 01 01 2019. Proprietary Information of UnitedHealthcare Copyright 2019 United HealthCare Services Inc. CPT Code Description, Craniectomy or craniotomy for implantation of neurostimulator electrodes cerebral. Twist drill burr hole craniotomy or craniectomy with stereotactic implantation of. neurostimulator electrode array in subcortical site e g thalamus globus pallidus. subthalamic nucleus periventricular periaqueductal gray without use of. intraoperative microelectrode recording first array. Twist drill burr hole craniotomy or craniectomy with stereotactic implantation of. neurostimulator electrode array in subcortical site e g thalamus globus pallidus. 61864 subthalamic nucleus periventricular periaqueductal gray without use of. intraoperative microelectrode recording each additional array List separately in. addition to primary procedure, Twist drill burr hole craniotomy or craniectomy with stereotactic implantation of. neurostimulator electrode array in subcortical site e g thalamus globus pallidus. subthalamic nucleus periventricular periaqueductal gray with use of intraoperative. microelectrode recording first array, Twist drill burr hole craniotomy or craniectomy with stereotactic implantation of.
neurostimulator electrode array in subcortical site e g thalamus globus pallidus. 61868 subthalamic nucleus periventricular periaqueductal gray with use of intraoperative. microelectrode recording each additional array List separately in addition to primary. Insertion or replacement of cranial neurostimulator pulse generator or receiver. direct or inductive coupling with connection to a single electrode array. Insertion or replacement of cranial neurostimulator pulse generator or receiver. direct or inductive coupling with connection to 2 or more electrode arrays. 64999 Unlisted procedure nervous system, CPT is a registered trademark of the American Medical Association. HCPCS Code Description, L8679 Implantable neurostimulator pulse generator any type. L8680 Implantable neurostimulator electrode each, L8682 Implantable neurostimulator radiofrequency receiver. Implantable neurostimulator pulse generator single array rechargeable includes. Implantable neurostimulator pulse generator single array nonrechargeable includes. Implantable neurostimulator pulse generator dual array rechargeable includes. Implantable neurostimulator pulse generator dual array nonrechargeable includes. DESCRIPTION OF SERVICES, Deep Brain Stimulation, Deep brain stimulation DBS delivers electrical pulses to select areas of the brain e g the internal globus pallidus. interna GPi subthalamic nucleus STN or ventral intermediate nucleus VIM of the thalamus via surgically. implanted electrodes The mechanism of action is not completely understood but the goal of DBS is to interrupt the. pathways responsible for the abnormal movements associated with movement disorders such as Parkinson s disease. and essential tremor The exact location of electrodes depends on the type of disorder being treated and unlike. standard surgical ablation which causes permanent destruction of the targeted area DBS is reversible and adjustable. The DBS device consists of an implantable pulse generator IPG or neurostimulator an implantable lead with. electrodes and a connecting wire The neurostimulator is approximately the size of a stop watch and is similar to a. cardiac pacemaker Subcutaneous extension wires connect the lead s to the neurostimulator which is implanted near. the clavicle or in the case of younger individuals with primary dystonia in the abdomen Conventional deep brain. stimulation systems deliver stimulation using cylindrical electrodes or Ring Mode omnidirectional stimulation which. stimulate neurons around the entire circumference of the lead Directional deep brain stimulation uses a directional. lead designed to steer electrical current to relevant areas of the brain while avoiding areas that may cause side effects. Deep Brain and Cortical Stimulation Page 3 of 19, UnitedHealthcare Commercial Medical Policy Effective 01 01 2019.
Proprietary Information of UnitedHealthcare Copyright 2019 United HealthCare Services Inc. Several independent electrode contacts can be programmed creating a more customized therapy The St Jude. Medical InfinityTM DBS System is used for directional deep brain stimulation. When used according to U S Food and Drug Administration FDA indications deep brain stimulation is used to treat. selected individuals with Parkinson s disease essential tremor and primary dystonia Most forms of Parkinson s. disease are idiopathic having no specific known cause In secondary Parkinsonism the symptoms are a result of. head trauma metabolic conditions toxicity drugs or other medical disorders Primary dystonia occurs on its own. apart from any illness Secondary dystonia can occur with illness after trauma or following exposure to certain. medications or toxins Types of dystonia include, Generalized Affects multiple areas of the body. Focal Affects one specific area of the body such as the neck cervical dystonia or torticollis eyelid. blepharospasm or hand writer s cramp, Segmental Affects two or more adjacent parts of the body. Multifocal Affects two nonadjacent parts of the body. Hemidystonia Affects one side of the body, Cervical dystonia or torticollis. Responsive Cortical Stimulation Closed Loop Implantable Neurostimulator. The RNS System NeuroPace Inc is intended to detect abnormal electrical brain signals that precede seizures and. deliver electrical stimulation in response to try to normalize electrical brain activity and prevent seizures The device. includes a neurostimulator that is placed in the skull and leads that are placed in the seizure originating areas of the. brain The system s intended benefits include seizure prevention fewer adverse events than other neurostimulation. methods and data transmission from the individual s home to clinicians. BENEFIT CONSIDERATIONS, In certain benefit documents for example the 2001 Certificate of Coverage Humanitarian Use Devices HUDs. require Institutional Review Board IRB oversight and are considered to be investigational and not covered In other. benefit documents for example the 2007 Certificate of Coverage and subsequent versions HUDs are not considered. to be investigational and are covered when used for proven indications Please consult the member specific benefit. plan document for details, CLINICAL EVIDENCE, Deep Brain Stimulation.
Parkinson s Disease and Essential Tremor, Evidence from available published studies indicates that deep brain stimulation DBS provides clinically and. statistically significant improvements in patients with Parkinson s disease PD and essential tremor ET. In a meta analysis Peng et al 2018 assessed the long term efficacy of deep brain stimulation DBS of the. subthalamic nucleus STN and globus pallidus interna GPi for Parkinson disease PD A total of 5 studies with 890. subjects 437 patients in the STN DBS group and 453 patients in the GPi DBS group were included in the analysis. The study results showed no significant differences between STN DBS and GPi DBS in the long term efficacy of unified. Parkinson disease rating scale section UPDRS III scores including motor subtypes The authors concluded that STN. DBS and GPi DBS improve motor function and activities of daily living for PD. Roper et al 2016 conducted a systematic review and meta analysis on gait speed in patients with PD to summarize. the effectiveness of DBS A random effects model meta analysis on 27 studies revealed a significant overall. standardized mean difference medium effect size equal to 0 60 Based on the synthesis of the 27 studies the authors. determined the following 1 a significant and medium effect size indicating DBS improves gait speed 2 DBS. improved gait speed regardless of whether the patients were tested in the on or off medication state and 3 both. bilateral and unilateral DBS led to gait speed improvement According to the authors the current analysis provides. objective evidence that both unilateral and bilateral DBS provide a therapeutic benefit on gait speed in persons with. Tan et al 2016 conducted a systematic review and meta analysis to compare DBS stimulation of globus pallidus. internus GPi and subthalamic nucleus STN which are the most targeted locations for the procedure Clinical. outcomes of motor function non motor function and quality of life QOL were collected for the meta analysis Ten. eligible trials with 1 034 patients were included in the analysis Unified Parkinson s disease rating scale III UPDRS III. scores were collected at 6 12 and 24 months postsurgery separately to assess the motor function of the patients A. statistically significant effect in favor of the GPi DBS was obtained in the off medication on stimulation phase of. UPDRS III at 12 months However GPi DBS showed an opposite result at 24 months In the on medication on. stimulation phase GPi DBS obtained a worse outcome compared with STN DBS Compared with STN DBS increased. Deep Brain and Cortical Stimulation Page 4 of 19, UnitedHealthcare Commercial Medical Policy Effective 01 01 2019. Proprietary Information of UnitedHealthcare Copyright 2019 United HealthCare Services Inc. dosage of levodopa equivalent doses was needed in GPi DBS Meanwhile Beck Depression Inventory II scores. demonstrated that STN has a better performance As for neurocognitive phase postsurgery GPi DBS showed better. performance in three of the nine tests especially in verbal fluency Use of GPi DBS was associated with a greater. effect in eight of the nine subscales of QOL The authors concluded that GPi and STN DBS significantly improve. advanced Parkinson s patients symptoms functionality and QOL According to the authors the question regarding. which target is superior remains open for discussion An understanding of the target selection depends on individual. symptoms neurocognitive mood status therapeutic goals of DBS e g levodopa reduction and surgical expertise. In a meta analysis of randomized controlled trials RCTs Perestelo Perez et al 2014 describe. that may require coverage for a specific service The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested CPT HCPCS Codes Required Clinical Information Deep Brain and Cortical Stimulation 61863 61864 61867 61868 61885

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