SUBJECT: LCD DL35094, Non-coverage for MRgFUS for Essential Tremor
Dear Dr. Patterson:
The American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS)
and American Society for Stereotactic and Functional Neurosurgery (ASSFN) appreciate the opportunity
to comment on the proposed local coverage determination (LCD) titled “Services That are not
Reasonable and Necessary: L35094.” In particular, we are concerned about the inclusion on this list of
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor,
reported with CPT Category III Code 0398T. We strongly urge Novitas to remove this procedure from
the non-covered list and to begin the process of issuing a positive coverage policy for MRgFUS for the
treatment of idiopathic essential tremor (ET) patients with medication-refractory tremor.
Novitas is an outlier among other Medicare payors regarding coverage for this important procedure.
Currently, six Medicare Administrative Contractors (MACs) provide coverage for MRgFUS.
Neurosurgery has actively participated with several MACs to support coverage for MRgFUS for
appropriately selected patients and provided guidance regarding details of their policies. We welcome
the opportunity to share our expertise on this subject.
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Read full letter here
