SUBJECT: LCD DL37421-Draft LCD for MRgFUS for Essential Tremor
Dear Dr. Haug,
The American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS)
and the American Association of Stereotactic and Functional Neurosurgery (ASSFN) appreciate the
opportunity to comment on the proposed local coverage determination (LCD) titled “Magnetic Resonance
Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor: DL37421.” Based on
the current literature, we request that National Government Services (NGS), Inc., cover unilateral
MRgFUS thalamotomy for patients with essential tremor (ET) who cannot be controlled with medication
or who are not candidates for Deep Brain Stimulation (DBS) therapy.
Approved procedures for treatment of ET currently include:
- CPT 61720 Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus;
- CPT 61863 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array;
- CPT 61867 Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array; and the associated “additional array” codes (CPT +61864, CPT +61868).
All of these codes require passing a probe through brain tissue, and in the case of CPT 61720, also
require creating a lesion with a radiofrequency (RF) probe.
…
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