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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
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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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