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6.3.37.10.1 Prior Authorization VNS
The surgical implantation and purchase of VNS devices may be considered for prior authorization with the following diagnosis codes: 34541 or 34551.
The surgical implantation of VNS may be reimbursed using procedure code 61885, 61886, 64553, or 64573.
VNS are not a benefit of Texas Medicaid in the following cases:
• For the treatment of clients with an absent left vagus nerve
•For the treatment of clients with depression
•For the treatment of clients with progressive fatal or medical diseases with a poor prognosis
Disabilities due to mental retardation or cerebral palsy may confound the assessment of benefits resulting from VNS. When a diagnosis of mental retardation or cerebral palsy exists, the treating physician must document in the medical record how VNS will measurably benefit the client in spite of mental retardation or cerebral palsy.
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