Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor and Tremor Dominant Parkinson's Disease
L37729
MRgFUS unilateral thalamotomy is covered for patients with idiopathic essential tremor or tremor-dominant Parkinson's disease whose tremor is medication-refractory (failure of ≥2 medication trials including ≥1 first-line agent), who have moderate-to-severe postural or intention tremor of the dominant hand and disabling tremor (CRST disability item ≥2), and who are not candidates for DBS (e.g., due to age, anticoagulation, comorbidities or failed DBS without retained cranial implants). Coverage excludes treatment of head or voice tremor, bilateral thalamotomy, advanced neurodegenerative disease, unstable cardiac disease, severe depression or cognitive impairment that impairs consent or benefit, and cases with MRI contraindication or skull characteristics (SDR) that preclude safe/effective MRgFUS. Certain truncated items in the policy (specific cognitive score thresholds and numeric SDR cutoffs) require manual review for precise documentation and exclusion criteria.