PA Lookup

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

2 units per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

2 units per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Approximately 40 percent of all individuals with epilepsy have medically refractory seizures.

Primarily generalized seizures are the most common type of intractable seizures in children;

while in adults, complex partial seizures are the most common intractable seizure type. Medically refractory seizures are those seizures that are not completely controlled by medical therapy. That means that seizures continue to occur despite treatment with a maximally tolerated dose of a firstline anti-epilepsy drug (AED) as monotherapy or in at least one combination with an adjuvant medication. The terms "intractable" or "medically refractory" are interchangeable.

In the past 10 years, significant advances have occurred in surgical treatment for epilepsy and in medical treatment of epilepsy with newly developed and approved medications. Despite these advances, however, 25–50 percent of patients with epilepsy experience breakthrough seizures or suffer from debilitating adverse effects of antiepileptic drugs. Vagus Nerve Stimulation (VNS) has been investigated as a treatment alternative in patients with medically refractory partial-onset seizures for whom surgery is not recommended or for whom surgery has failed.

Vagus Nerve Stimulation (VNS) is performed by an implantable stimulator as a treatment for refractory seizures. VNS treatment sends preprogrammed, intermittent electrical pulses through the vagus nerve in the neck to the brain. These pulses originate in a small generator device that is implanted in the chest. The exact mechanism of the antiepileptic effects of VNS are not fully understood, but the procedure may reduce the severity or the frequency of seizures in selected candidates who have an intact vagus nerve.

Exclusions

Medicaid covers VNS for the treatment of seizures when it is determined to be medically necessary because BOTH of the following criteria are met:

• a. The beneficiary has medically refractory* seizures; AND *Medically refractory means 1. seizures that occur in spite of therapeutic levels of anti-epileptic drugs; OR 2. seizures that cannot be treated with therapeutic levels of antiepileptic drugs because of intolerable adverse side effects.
• b. The beneficiary has failed or is not eligible for surgical treatment.

Additional Service Specifics

Inpatient Hospital, Outpatient Hospital, and Independent Diagnostic Testing Facility (IDTF) for services 95976, 95977, 95983, and 95984.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No.:1A-33
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Approximately 40 percent of all individuals with epilepsy have medically refractory seizures.

Primarily generalized seizures are the most common type of intractable seizures in children;

while in adults, complex partial seizures are the most common intractable seizure type. Medically refractory seizures are those seizures that are not completely controlled by medical therapy. That means that seizures continue to occur despite treatment with a maximally tolerated dose of a firstline anti-epilepsy drug (AED) as monotherapy or in at least one combination with an adjuvant medication. The terms "intractable" or "medically refractory" are interchangeable.

In the past 10 years, significant advances have occurred in surgical treatment for epilepsy and in medical treatment of epilepsy with newly developed and approved medications. Despite these advances, however, 25–50 percent of patients with epilepsy experience breakthrough seizures or suffer from debilitating adverse effects of antiepileptic drugs. Vagus Nerve Stimulation (VNS) has been investigated as a treatment alternative in patients with medically refractory partial-onset seizures for whom surgery is not recommended or for whom surgery has failed.

Vagus Nerve Stimulation (VNS) is performed by an implantable stimulator as a treatment for refractory seizures. VNS treatment sends preprogrammed, intermittent electrical pulses through the vagus nerve in the neck to the brain. These pulses originate in a small generator device that is implanted in the chest. The exact mechanism of the antiepileptic effects of VNS are not fully understood, but the procedure may reduce the severity or the frequency of seizures in selected candidates who have an intact vagus nerve.

Exclusions

Medicaid covers VNS for the treatment of seizures when it is determined to be medically necessary because BOTH of the following criteria are met:

• a. The beneficiary has medically refractory* seizures; AND *Medically refractory means 1. seizures that occur in spite of therapeutic levels of anti-epileptic drugs; OR 2. seizures that cannot be treated with therapeutic levels of antiepileptic drugs because of intolerable adverse side effects.
• b. The beneficiary has failed or is not eligible for surgical treatment.

Additional Service Specifics

Inpatient Hospital, Outpatient Hospital, and Independent Diagnostic Testing Facility (IDTF) for services 95976, 95977, 95983, and 95984.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No.:1A-33
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Limits

1 unit per date of service

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Approximately 40 percent of all individuals with epilepsy have medically refractory seizures.

Primarily generalized seizures are the most common type of intractable seizures in children;

while in adults, complex partial seizures are the most common intractable seizure type. Medically refractory seizures are those seizures that are not completely controlled by medical therapy. That means that seizures continue to occur despite treatment with a maximally tolerated dose of a firstline anti-epilepsy drug (AED) as monotherapy or in at least one combination with an adjuvant medication. The terms "intractable" or "medically refractory" are interchangeable.

In the past 10 years, significant advances have occurred in surgical treatment for epilepsy and in medical treatment of epilepsy with newly developed and approved medications. Despite these advances, however, 25–50 percent of patients with epilepsy experience breakthrough seizures or suffer from debilitating adverse effects of antiepileptic drugs. Vagus Nerve Stimulation (VNS) has been investigated as a treatment alternative in patients with medically refractory partial-onset seizures for whom surgery is not recommended or for whom surgery has failed.

Vagus Nerve Stimulation (VNS) is performed by an implantable stimulator as a treatment for refractory seizures. VNS treatment sends preprogrammed, intermittent electrical pulses through the vagus nerve in the neck to the brain. These pulses originate in a small generator device that is implanted in the chest. The exact mechanism of the antiepileptic effects of VNS are not fully understood, but the procedure may reduce the severity or the frequency of seizures in selected candidates who have an intact vagus nerve.

Exclusions

Medicaid covers VNS for the treatment of seizures when it is determined to be medically necessary because BOTH of the following criteria are met:

• a. The beneficiary has medically refractory* seizures; AND *Medically refractory means 1. seizures that occur in spite of therapeutic levels of anti-epileptic drugs; OR 2. seizures that cannot be treated with therapeutic levels of antiepileptic drugs because of intolerable adverse side effects.
• b. The beneficiary has failed or is not eligible for surgical treatment.

Additional Service Specifics

Inpatient Hospital, Outpatient Hospital, and Independent Diagnostic Testing Facility (IDTF) for services 95976, 95977, 95983, and 95984.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No.:1A-33
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

Deep brain stimulation (DBS) consists of electrical stimulation of specific sites in the brain with implanted electrodes to reduce the symptoms of movement disorders such as Parkinson’s disease and Essential Tremor. DBS can be done on one or both sides of the brain, depending on the disorder and the beneficiary's symptoms. Once implanted, noninvasive programming of the stimulator can be adjusted to the patient’s symptoms. This is an important feature for patients, whose disease may progress over time, requiring different stimulation parameters. Setting the best stimulation parameters may involve the balance between optimal symptom control and the appearance of side effects of stimulation, such as dysarthria, disequilibrium, or involuntary movements.

Exclusions

DBS is contraindicated when any of the following are true:

• a. Medical, surgical, neurologic, or orthopedic co-morbidities exist

contraindicating DBS surgery or stimulation.

• b. One or more medical conditions exist that require repeated magnetic

resonance imaging (MRI). MRI can be safely performed under specialized protocols.

• c. Cognitive impairment, dementia, or depression would be worsened by or

would interfere with the beneficiary’s ability to benefit from DBS.

• d. Botulinum toxin injections have been given within the last 4 months.
• e. Diathermy will be used in the future.

Place of Service

Inpatient, Outpatient, and Independent Diagnostic Testing Facilities (IDTF). CPT codes 95970, 95976 and 95977 may be billed in the office setting. CPT codes 95976 and 95977 may be billed in IDTF Centers.

How to Submit

N/A - No authorization is required

Resources

• Clinical Coverage Policy No: 1A-26
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required