61715
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Claims must follow billing and coding guidelines that complement LCD L37761; required documentation, coding details, and any prior authorization requirements are specified in LCD L37761 and local Medicare contractor guidance.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code(s) must best describe the patient's condition for which the service was performed.
- For diagnostic tests, report the result of the test if known; otherwise report the symptoms prompting performance of the test.
Key Coverage Criteria
- Clinical indications and medical necessity criteria for MRgFUS for Essential Tremor are defined in Local Coverage Determination L37761; consult LCD L37761 for specific diagnostic criteria and thresholds.
- MRgFUS may be billed for treatment of essential tremor only when reasonable and necessary requirements in LCD L38495 are met.
- Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS; CPT 0398T) may be furnished for treatment of neurologic conditions when medically indicated per the applicable Local Coverage Determination (LCD).
- Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS, CPT 61715) may be billed for treatment of tremor when performed in accordance with the applicable Local Coverage Determination (LCD).
- MRgFUS unilateral thalamotomy is covered for Essential Tremor (ET) that is medication-refractory after at least two trials including one first-line agent, with moderate-to-severe postural or intention hand tremor (CRST tremor score ≥2) and disabling tremor (CRST disability item ≥2), in patients who are not surgical candidates for DBS.
- MRgFUS unilateral thalamotomy is covered for Tremor-Dominant Parkinson's Disease (TDPD) refractory or intolerant to levodopa (or with LEDD ≥900 mg), with an on-medication UPDRS tremor-to-PIGD mean-item ratio ≥1.5, moderate-to-severe postural or intention hand tremor (CRST tremor score ≥2), disabling tremor (CRST disability item ≥2), and not a surgical candidate for DBS.
20 Active Policies
A60325 — Billing and Coding: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
J06
A57435 — Billing and Coding: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
J06
L40279 — Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
J06
L37421 — Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
J06
Related Codes
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