Selective Peripheral Denervation (Bertrand Procedure)

Selective peripheral denervation (Bertrand procedure) is covered for severe, disabling spasmodic torticollis (ICD‑10 G24.3) only when symptoms are disabling and the member has failed an appropriate course of pharmacotherapy or experienced intolerable adverse effects or developed resistance to botulinum toxin type A or B, and the procedure is performed for cervical dystonia by clinicians with specialized expertise. It is considered experimental/investigational and not covered when those criteria are not met, when combined with deep brain stimulation, or when used as selective peripheral neurectomy for upper‑limb spasticity (ICD‑10 G80.1).

"Procedure is indicated exclusively in cervical dystonia (per EFNS/MDS-ES statement cited in background)."

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