1 / 3

Medicare Coverage for Vagus Nerve Stimulation (VNS)

<br>We shared information about Medicare coverage for VNS for your reference, for detailed understanding, you can contact us.<br><br>Read More: https://bit.ly/3RQfMiJ<br>

alicecarlosmbc
Download Presentation

Medicare Coverage for Vagus Nerve Stimulation (VNS)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Visit our website: Click here Follow us: Medicare Coverage for Vagus Nerve Stimulation (VNS) Vagus Nerve Stimulation (VNS) is a pulse generator, similar to a pacemaker, that is surgically implanted under the skin of the left chest and an electrical lead (wire) is connected from the generator to the left vagus nerve. Electrical signals are sent from the battery-powered generator to the vagus nerve via the lead. These signals are in turn sent to the brain. VNS provides indirect modulation of brain activity through the stimulation of the vagus nerve. The vagus nerve, the tenth cranial nerve, has parasympathetic outflow that regulates the autonomic (involuntary) functions of heart rate and gastric acid secretion and also includes the primary functions of sensation from the pharynx, muscles of the vocal cords, and swallowing. It is a nerve that carries both sensory and motor information to/from the brain. Medicare coverage for many tests, items, and services depends on where you live. Nationally Covered Indications VNS treatment is reasonable and necessary for patients with medically refractory partial-onset seizures for whom surgery is not recommended or for whom surgery has failed. Effective for services performed on or after February 15, 2019, the Centers for Medicare & Medicaid Services (CMS) will cover FDA-approved vagus nerve stimulation (VNS) devices for treatment- resistant depression (TRD) through Coverage with Evidence Development (CED) when offered Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 1

  2. Visit our website: Click here Follow us: in a CMS-approved, double-blind, randomized, placebo-controlled trial with a follow-up duration of at least one year with the possibility of extending the study to a prospective longitudinal study when the CMS-approved, double-blind, randomized placebo-controlled trial has completed enrollment, and there are positive interim findings. Nationally Non-Covered Indications VNS is not reasonable and necessary for all other types of seizure disorders that are medically refractory and for whom surgery is not recommended or for whom surgery has failed. VNS is non-covered for treatment-resistant depression (TRD) when furnished outside of a CMS- approved Coverage with Evidence Development (CED) study. All other indications of VNS for the treatment of depression are nationally non-covered. Patient Criteria The following criteria must be used to identify patients demonstrating treatment-resistant depression (TRD): The patient must be in a major depressive disorder (MDD) episode for ≥ two years or have had at least four episodes of MDD, including the current episode. In order to confirm the patient has MDD, accepted diagnostic criteria from the most current edition of the Diagnostic and Statistical Manual for Mental Disorder (DSM) and a structured clinical assessment are to be used. The patient’s depressive illness meets a minimum criterion of four prior failed treatments of adequate dose and duration as measured by a tool designed for this purpose. The patient is experiencing a major depressive episode (MDE) as measured by a guideline-recommended depression scale assessment tool on two visits, within a 45-day span prior to implantation of the VNS device. Patients must maintain a stable medication regimen for at least four weeks before device implantation. If patients with bipolar disorder are included, the condition must be carefully characterized. The applicable CPT code for VNS is CPT® code 64568: Incision for implantation of cranial nerve (e.g. vagus nerve) neurostimulator electrode array and pulse generator. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 2

  3. Visit our website: Click here Follow us: The patient’s medical record must contain documentation that fully supports the medical necessity for services included within the Coverage Indications, Limitations, and/or Medical Necessity section within the related LCD. This documentation includes but is not limited to, appropriate use criteria, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. We shared information about Medicare coverage for Vagus Nerve Stimulation (VNS) for your reference, for a detailed understanding, you can refer to “Medicare National Coverage Determinations Manual Chapter 1, Part 2”.MedicalBillersandCoders (MBC) is a leading revenue cycle company providing complete medical billing services. If you need any assistance in medical billing and coding for at info@medicalbillersandcoders.com / 888-357-3226. your practice, you can contact us CPT © Copyright 2022 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association. Copyright © Medical Billers and Coders. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 3

More Related