C1607 — Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Implantation of a vagus nerve stimulation device is consideredmedically necessaryin an individual with medically and surgically refractory seizures as evidenced by:Failure of more than one trial of single or combination antiepileptic medications, as evidenced by persistent seizures or intolerable side effects of drug therapy; andIndividual has failed or is not a candidate for resective epilepsy surgery.
- Failure of more than one trial of single or combination antiepileptic medications, as evidenced by persistent seizures or intolerable side effects of drug therapy; and
- Individual has failed or is not a candidate for resective epilepsy surgery.
- Electronic analysis of an implanted neurostimulator pulse generator system for vagus nerve stimulation is consideredmedically necessarywhen the implantation occurred because the above criteria were met.
- Replacement or revision of an implanted neurostimulator pulse generator system (with or without lead changes) for vagus nerve stimulation is consideredmedically necessarywhen:The implantation occurred because the above criteria were met;andThe current implanted device is no longer functioning appropriately.
- The implantation occurred because the above criteria were met;and
1 Active Policy
ANTHEM-CG-SURG-120 — CG-SURG-120 Vagus Nerve Stimulation
Related Codes
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