LCD/NCD Portal

NCD160.18 VAGUS NERVE STIMULATION (VNS)

 

Effective Date of this Version

• 7/23/2007

 

Benefit Category

• Durable Medical Equipment.

• Incident to a physician's professional Service.

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

A. General

• 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. FDA approved VNS for treatment of refractory epilepsy in 1997 and for resistant depression in 2005.

 

Indications and Limitations of Coverage

 

Nationally Covered Indications

• Effective for services performed on or after July 1, 1999, VNS is reasonable and necessary for patients with medically refractory partial onset seizures for whom surgery is NOT recommended or for whom surgery has failed.

 

Nationally Non-Covered Indications

• Effective for services performed on or after July 1, 1999, VNS is NOT reasonable and necessary for all other types of seizure disorders which are medically refractory and for whom surgery is not recommended or for whom surgery has failed.

• Effective for services performed on or after May 4, 2007, VNS is NOT reasonable and necessary for resistant depression. (Information on the national coverage analysis leading to this determination can be found at: http://www.cms.gov/mcd/viewnca.asp?where=index&nca_id=195.)

 

Other

• Also see §160, "Electrical Nerve Stimulators."

• (This NCD last reviewed May 2007.)

 

Claims Processing Instructions

• TN 1271(Medicare Claims Processing)

 

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/R70NCD.pdf

 

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• First reconsideration for Vagus Nerve Stimulation for Treatment of Resistant Depression (TRD) (CAG-00313R)

 

 

Medicare NCD Link