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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.43 Neurostimulators : 9.2.43.13 Vagal Nerve Stimulators (VNS)

9.2.43.13
VNS are a benefit of Texas Medicaid when medically necessary and prior authorized, for the treatment of intractable partial onset seizures.
VNS involves the use of devices that deliver electrical pulses to the cervical portion of the vagus nerve by an implanted generator.
9.2.43.13.1
The surgical implantation and purchase of VNS devices may be considered for prior authorization for clients with partial onset intractable seizures when there is failure, contraindication, or intolerance to all suitable medical and pharmacological management.
The surgical implantation of VNS may be reimbursed using procedure code 61885, 61886, 64553, or 64568.
VNS are not a benefit of Texas Medicaid in the following cases:
Incapacities due to intellectual disabilities or cerebral palsy may confound the assessment of benefits resulting from VNS. When a diagnosis of intellectual disabilities or cerebral palsy exists, the treating physician must document in the client’s medical record how VNS will measurably benefit the client in spite of intellectual disabilities or cerebral palsy.

Texas Medicaid & Healthcare Partnership
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