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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.44 Neurostimulators : 8.2.44.11 Prior Authorization of Neurostimulator Devices Procedure Codes

8.2.44.11
The following device procedure codes may be reimbursed with prior authorization:
To identify the service as a VNS device, procedure code L8686 must be submitted with modifier TG. Only one similar device code may be reimbursed per date of service for any client.

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