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

MRgFUS unilateral thalamotomy is covered for medication-refractory Essential Tremor and for tremor-dominant Parkinson’s disease meeting specified levodopa/LEDD and UPDRS tremor-ratio criteria, provided patients have moderate-to-severe hand tremor and disabling tremor and are not candidates for DBS. Bilateral MRgFUS for ET is allowed only as a staged procedure with the second side ≥9 months after the first when unilateral criteria are met. Coverage excludes treatment of head/voice tremor, bilateral thalamotomy for PD, certain medical and neurologic contraindications (e.g., MRI contraindication, unfavorable skull density, severe depression, cognitive impairment, pregnancy, prior specified brain procedures), and requires documentation of medication trials, CRST/UPDRS scores, LEDD, depression and cognitive screening, skull density assessment, and MRI compatibility.

"Unilateral MRgFUS thalamotomy is covered for medication-refractory Essential Tremor (ET) defined as failure of at least two trials of medical therapy including at least one first-line agent."