Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS) for the treatment of neurologic conditions
L37790
Unilateral MRgFUS thalamotomy is covered for medication-refractory Essential Tremor (failure of ≥2 medications including one first-line agent) and for Tremor-Dominant Parkinson's Disease refractory or intolerant to levodopa or with LEDD ≥900 mg, provided objective severity thresholds are met (UPDRS tremor/PIGD ratio ≥1.5, CRST tremor ≥2 and/or CRST disability ≥2) and the patient is not a candidate for DBS. Exclusions include head/voice tremor, bilateral thalamotomy, severe depression (PHQ-9 ≥20 or BDI-II >14), cognitive impairment, prior disqualifying brain procedures, MRI contraindication, inadequate skull density ratio, untreated coagulopathy, DVT risk, drug-induced Parkinsonism, seizures, brain tumor, and intracranial aneurysm/AVM requiring treatment.
"Unilateral MRgFUS thalamotomy is medically reasonable and necessary for medication-refractory Essential Tremor defined as refractory to at least two trials of medical therapy including at least one..."