Cerebellar Stimulation/Pacemaker

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MP 7.01.27

Cerebellar Stimulation/Pacemaker

Section Surgery	Original Policy Date 3/31/96	Last Review Status/Date Reviewed by consensus/4:2002
Issue 4:2002		Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

Description

Electrical stimulation of the cerebellum using arrays of electrodes surgically implanted on the anterior surface of the cerebellum has been proposed as one way to treat certain neurological disorders. Leads connected to the electrodes emerge through small openings in the skull and are placed subcutaneously down the neck to a stimulator implanted in a subcutaneous pocket below the clavicle on the anterior chest.

Policy

The use of the cerebellar stimulator/pacemaker is considered investigational.

Policy Guidelines

No applicable information

Benefit Application

No applicable information

Rationale

2002 Update

While two cerebellar stimulation devices have FDA 510K clearance, these devices are no longer marketed.

Codes	Number	Description
CPT	61870	Craniectomy for implantation of neurostimulator electrodes, cerebellar, cortical
	61875	Subcortical
	61885	Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling
ICD-9 Procedure	02.93	Implantation of intracranial neurostimulator
ICD-9 Diagnosis		Investigational for all codes
HCPCS	E0751	Implantable neurostimulator pulse generator/receiver
	E0753	Implantable neurostimulator electrodes/leads
Type of Service	Surgery
Place of Service	Inpatient

Index

Cerebellar stimulator/pacemaker
Electrical nerve stimulation, cerebellar stimulator/pacemaker
Stimulation, electrical, cerebellar

Policy History

Date	Action	Reason
03/31/96	Add to Surgery section	New Policy
12/18/02	Replace policy	Policy updated and retired.

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