Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor

MRgFUS unilateral thalamotomy and unilateral pallidotomy are covered for medication-refractory Essential Tremor and tremor-dominant Parkinson's disease respectively when objective severity thresholds are met (CRST tremor ≥2 and disability ≥2; UPDRS tremor-to-PIGD ratio ≥1.5 for PD) and patients are not candidates for DBS. Bilateral thalamotomy for ET is allowed only as a staged procedure with at least a 9-month interval; multiple medical and surgical contraindications (e.g., MRI incompatibility, untreated coagulopathy, severe depression, pregnancy, prior certain brain procedures) and specified exclusions (head/voice tremor, bilateral thalamotomy for PD) preclude coverage.

"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 intent..."