CMS is considering issuing a national coverage policy that would allow Medicare payment for vagus nerve stimulation for treatment-resistant depression (TRD) and is
seeking comment about the idea.
Medicare already covers vagus nerve stimulation to treat medically refractory partial onset seizures, when surgery is not recommended or has failed (Medicare National Coverage Determinations Manual,
Section 160.18). That policy took effect in 1999.
CMS considered expanding that policy to include treatment for TRD once already – in 2007 -- but decided the science wasn’t there to support it at that time. The agency announced May 30 that it is considering revisiting that decision at the
request of the U.K.-based company
LivaNova PLC, which manufactures vagus nerve stimulators.
Vagus nerve stimulation involves implanting a small generator to send mild electrical pulses to the brain through electrodes that are placed on the vagus nerve. Surgical placement is reported with CPT code 64568 (Incision for implantation of cranial nerve [e.g., vagus nerve] neurostimulator electrode array and pulse generator).
The deadline for public comment to CMS is June 29. CMS says it would especially like to receive comments backed up by scientific evidence. It will issue a proposed decision memo at the end of November.
The vagus is the longest cranial nerve, passing through the neck and chest to the abdomen. It includes both motor and sensory fibers and affects such varied functions as swallowing, involuntary muscle and gland control and the senses of taste and touch,
according to Medscape.