TMPPM 2008 > Texas Medicaid Services > Physician > Procedures and Services

36.4.7.5 Vagal Nerve Stimulators

The implantation, revision, programming/reprogramming, and removal of the vagal nerve stimulator device is a benefit for the Texas Medicaid Program clients with medically intractable partial onset seizures.

These procedures are payable for inpatient, ASC, and HASC. If performed in an ASC or HASC, the maximum reimbursement is determined by the payment grouping.

No separate payment for the device is made to either the hospital or the physician. Reimbursement for the device is included in the facility payment.

The following procedure codes are payable for the incision, implantation, revision, or removal of the vagal nerve stimulator: 2/F-61885, 2/F-64573, 2/F-64585, and 2/F-61888.

The following diagnosis codes must be billed for procedure codes 2/F-61885 and 2/F-61888 when requesting the vagal nerve stimulator: 34511, 34541, and 34551.

The following procedure codes are payable in an outpatient setting or physician office for the electronic analysis and programming/reprogramming of the implanted neurostimulator: 5-95970, 5-95971, 5-95972, 5-95973, 5-95974, 5-95975, 5-95978, and 5-95979. These procedure codes do not require prior authorization.

Clients with diagnoses with ominous prognoses or other limiting factors would not be considered appropriate candidates for the implantation of the vagal nerve stimulator (for example, clients with an absent left vagus nerve, severe mental retardation, cerebral palsy, stroke, progressive fatal neurologic diseases, or progressive fatal medical diseases).

Refer to: "THSteps-Comprehensive Care Program (CCP)" for children younger than 21 years of age.