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Focal seizures (previously referred to as partial seizures) arise from a discrete area of the brain and can cause a range of symptoms, depending on the seizure type and the brain area involved. Standard therapy for seizures includes treatment with one or more of various antiepileptic drugs (AEDs). Currently, response to AEDs is less than ideal; as a result, a substantial number of patients do not achieve good seizure control with medications alone.
Responsive neurostimulation (RNS), also known as responsive cortical stimulation, for the treatment of epilepsy involves the use of one or more implantable electric leads that serve 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 received U.S. Food and Drug Administration (FDA) approval for the treatment of refractory focal epilepsy in individuals ≥18 years of age. The system consists of an implantable neurostimulator, a cortical strip lead, a depth lead, a programmer and telemetry wand, and a patient data management system.
I. Responsive neurostimulation (RNS) may be considered MEDICALLY NECESSARY AND APPROPRIATE for patients with focal epilepsy who meet ALL of the following criteria:
II. Responsive neurostimulation is considered EXPERIMENTAL/INVESTIGATIVE for all other indications due to the lack of clinical evidence demonstrating an impact on improved health outcomes.
No additional statements.
Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.
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Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
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CPT® codes copyright American Medical Association® 2022. All rights reserved.
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