LCD/NCD Portal

NCD160.19

 

PHRENIC NERVE STIMULATOR

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Prosthetic Devices

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

 

Item/Service Description

• The phrenic nerve stimulator provides electrical stimulation of the patient's phrenic nerve to contract the diaphragm rhythmically and produce breathing in patients who have hypoventilation (a state in which an abnormally low amount of air enters the lungs).

o The device has been used successfully to treat hypoventilation caused by a variety of conditions, including respiratory paralysis resulting from lesions of the brain stem and cervical spinal cord and chronic pulmonary disease with ventilatory insufficiency.

o The phrenic nerve stimulator is intended to be an alternative to management of patients with respiratory insufficiency who are dependent upon the usual therapy of intermittent or permanent use of a mechanical ventilator as well as maintenance of a permanent tracheotomy stoma.

• However, an implanted phrenic nerve stimulator can be effective only if the patient has an intact phrenic nerve and diaphragm.

o Moreover, nerve injury may occur during the surgical procedure and if sufficient injury is incurred, the device will not prove useful to the patient.

o Consequently, it is possible for such a device to be indicated for a patient but, due to injury sustained during implant, fail to assist the patient, resulting in a return to the use of mechanical ventilation.

 

Indications and Limitations of Coverage

• The implantation of a phrenic nerve stimulator is covered for selected patients with partial or complete respiratory insufficiency.

 

Cross Reference

• See NCD on Electrical Nerve Stimulation, section 160.

 

 

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