Vagus and External Trigeminal Nerve Stimulation – Commercial and Individual Exchange Medical Policyopen_in_new

Implantable vagus nerve stimulation (VNS) is covered as medically necessary only for drug‑resistant epilepsy; implantable VNS is considered unproven/not medically necessary for all other listed conditions and all non‑implantable (transcutaneous) VNS and external trigeminal nerve stimulation devices are unproven/not medically necessary for any indication. Coverage requires documentation of failure of ≥2 antiepileptic drug trials (or intolerable AED side effects), that the patient is not a candidate for/has failed or refused epilepsy surgery after a Shared Decision Making discussion, no history of left or bilateral cervical vagotomy, and is subject to member benefit plan rules and medical‑record documentation.

"Implantable vagus nerve stimulators are proven and medically necessary for treating epilepsy in individuals with all of the following:"

Sign up to see full coverage criteria, indications, and limitations.