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

Unilateral MRgFUS thalamotomy is considered reasonable and necessary for medication-refractory essential tremor or tremor-dominant Parkinson’s disease when documented by objective scales (CRST for ET, UPDRS ratio for TDPD), functional disability, adequate medication trials (≥2 for ET) or LEDD considerations (policy references LEDD ≥ 900 mg), and when DBS has failed or is not tolerable. Exclusions include treatment of head/voice tremor, bilateral thalamotomy, certain comorbidities (unstable cardiac disease, coagulopathy, DVT risk), severe depression (PHQ-9 ≥ 20), certain prior brain procedures, MRI contraindication, and skull density ratio concerns; several exclusion thresholds (cognitive impairment score, skull density ratio) are missing from the provided text and require manual review.

"Unilateral MRgFUS thalamotomy is covered for essential tremor (ET) that is medication-refractory, defined as failure of at least 2 trials of medical therapy including at least 1 first-line agent."