Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy

Section: Surgery
Effective Date: November 01, 2019
Revised Date: October 05, 2019
Last Reviewed: September 26, 2019

Description

Responsive neurostimulation (RNS) for the treatment of epilepsy involves the use of one (1) or more implantable electric leads that serve as both a seizure detection and neurostimulation function. The device is programmed using a proprietary algorithm to recognize seizure patterns from electrocorticography output and to deliver electrical stimulation with the goal of terminating a seizure. One device, the Neuropace RNS System, has U.S. Food and Drug Administration (FDA) approval for the treatment of refractory partial epilepsy.

Criteria

RNS may be considered medically necessary for individuals with partial epilepsy who meet ALL of the following criteria:

  • Are 18 years of age or older; and
  • Have a diagnosis of partial-onset seizures with one (1) or two (2) well-localized seizure foci identified; and
  • Have an average of three (3) or more disabling seizures (e.g., motor partial seizures, complex partial seizures, or secondary generalized seizures) per month over the prior three (3) months; and
  • Are refractory to medical therapy (have failed two (2) or more appropriate antiepileptic medications at therapeutic doses); and
  • Are not candidates for focal resective epilepsy surgery (e.g., have an epileptic focus near eloquent cerebral cortex; have bilateral temporal epilepsy); and
  • Do not have any of the following contraindications for RNS placement :
    • Three or more specific seizure foci; or
    • Presence of primary generalized epilepsy; or
    • Presence of a rapidly progressive neurologic disorder.

RNS is considered experimental investigational and therefore non covered for all other indications. Scientific evidence does not support the use of RNS for any other indications.

Procedure Codes

61850 61860 61863 61864 61867 61868 61880
61885 61886 61888 95970 L8680 L8686 L8688

Diagnosis Codes

G40.011 G40.019 G40.111 G40.119 G40.211 G40.219 G40.311
G40.319 G40.A11 G40.A19 G40.B11 G40.B19 G40.411 G40.419
G40.803 G40.804

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