LCD/NCD Portal

NCD160.4

 

STEREOTACTIC CINGULOTOMY AS A MEANS OF PSYCHOSURGERY

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

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

 

Benefit Category

• Inpatient Hospital Services

• Physicians' Services

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

 

Item/Service Description

• Cingulotomy is a psychosurgical procedure designed to interrupt the interconnecting neuronal pathways of the brain involved in the regulation of the emotions and certain autonomic functions.

o The intent of psychosurgery is to modify or alter disturbances of behavior, thought content, or mood that are not responsive to other conventional modes of therapy, or for which no organic pathological cause can be demonstrated by established methods.

• The operation usually involves bilateral lesions that are placed in the anterior cingulum of the brain.

o Electrocautery probes are stereotactically inserted through lateral burr holes in the skull.

o A radio frequency pulsating current is used to ablate the tissue that connects the limbic system to the frontal lobe.

o Two or three repeat procedures may be performed in the same patient when a satisfactory result has not been achieved with the first cingulotomy.

 

Indications and Limitations of Coverage

• Stereotactic cingulotomy is NOT covered under Medicare because the procedure is considered to be investigational.

 

 

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