CurrentColorado Rocky Mountain Health PlansPolicy MMP061.11

Neurologic Services and Procedures

Defines coverage reference guidance and applicable procedure codes for magnetoencephalography (MEG), motor function mapping using non‑invasive navigated transcranial magnetic stimulation (nTMS), and vagus nerve stimulation (VNS) for stroke within the payer's Medicare Advantage context.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyNeurologic Services and Procedures

Policy CodePolicy MMP061.11

Change TypeNo material change

Effective DateJul 1, 2025

Next Review Date

Key ActionFollow applicable delegate prior authorization requirements or UnitedHealthcare Medicare Advantage prior authorization processes as required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3procedures described (MEG, nTMS, VNS)

4related/usage documents referenced

5CPT/HCPCS codes listed

Coverage Criteria and Policy Approach

Coverage references and approach

Coverage guidance and criteria are not established by Medicare NCDs or LCDs for these services; UnitedHealthcare applies internal criteria or refers to external criteria as indicated.

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Procedure and Device Codes

Magnetoencephalography (MEG) CPT CodesCPT

95965	Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization).
95966	Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization).

nTMS CodingCPT

64999

Unlisted procedure, nervous system (used for Motor Function Mapping Using Non-Invasive Navigated Transcranial Magnetic Stimulation (nTMS)).

Vagus Nerve Stimulation (VNS) CPT CodesCPT

64568

Open implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator.

VNS HCPCS / Device CodesHCPCS

C1827

Generator, neurostimulator (implantable), nonrechargeable, with implantable stimulation lead and external paired stimulation controller.

Prior Authorization & Provider Responsibilities

Prior Authorization

Prior Authorization Responsibility

For services that require prior authorization, responsibility for obtaining prior authorization rests with the provider submitting the claim unless the payer has delegated utilization management to another entity. When a delegate manages utilization management and prior authorization requirements for UnitedHealthcare Medicare Advantage members, providers must follow the delegate's prior authorization requirements and processes.

Delegate-managed prior authorization requirements must be followed when applicable.
Providers remain responsible for ensuring a prior authorization is obtained before providing services that require one, per member plan rules.

Documentation Required

Documentation Expectations

Providers must retain complete and accurate clinical and administrative documentation to support medical necessity and coding for services billed. Documentation should be available upon request and must align with the member-specific benefit plan and any applicable Medicare Advantage or delegate requirements.

Keep clinical records that justify the level of service provided.
Be prepared to submit documentation to the payer or delegate when requested.

Billing Rule

Provider Billing & Coding Responsibility

Providers are responsible for submitting accurate claims that reflect the services rendered and supported documentation. Listing of a code in policy does not indicate coverage or a guarantee of payment; benefit coverage is determined by the member's specific plan document and applicable laws.

Accurate coding and billing are required to support coverage decisions.
Inclusion of a code in this policy is for reference only and does not imply coverage.

Note

Provider Action Note

Medicare Advantage policy documents are informational and intended to support coverage decisions; they do not replace the member-specific benefit plan. Providers and treating physicians must exercise independent clinical judgment. For questions about a member's specific coverage, contact the customer service number on the back of the member ID card or refer to the Administrative Guide.

This policy is a guide — the member specific benefit plan supersedes it in case of conflict.
Contact customer service or the Administrative Guide for plan-specific details.

Clinical Background

Magnetoencephalography (MEG) is a noninvasive neurophysiologic technique that records and analyzes spontaneous or evoked brain magnetic activity to localize functional cortical regions, most commonly used for epileptic focus localization and for mapping sensory, motor, visual, or language cortex. MEG is described alongside other advanced neurodiagnostic and neuromodulation technologies in this policy; where applicable, the policy refers readers to external coverage guidance (for example, InterQual) or to related UnitedHealthcare commercial policies for clinical criteria for technologies such as non‑invasive navigated transcranial magnetic stimulation (nTMS) used for motor mapping and vagus nerve stimulation (VNS) used in the context of stroke care and implantable neurostimulator procedures.

Definitions and Key Terms

Magnetoencephalography (MEG) — definition and description

TermMagnetoencephalography (MEG)

DefinitionRecording and analysis of spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization) and evoked magnetic fields for single‑modality localization.

Coverage noteMedicare has no NCD and no LCD/LCA for MEG; refer to InterQual CP: Imaging, Imaging, Brain for coverage guidelines.

nTMS — definition and intended use for motor mapping

TermNavigated Transcranial Magnetic Stimulation (nTMS)

DefinitionNon‑invasive motor function mapping using navigated transcranial magnetic stimulation; used to map motor cortex function without invasive procedures.

Coverage noteMedicare has no NCD and no LCD/LCA for nTMS; for coverage guidance refer to UnitedHealthcare commercial policy 'Transcranial Magnetic Stimulation for Treating Physical Health Conditions'.

VNS for stroke — definition and brief description

TermVagus Nerve Stimulation (VNS) for stroke

DefinitionSurgical implantation of a cranial nerve neurostimulator electrode array and pulse generator to provide vagus nerve stimulation as a therapeutic intervention for stroke recovery.

Coding/Device noteCPT code 64568 describes open implantation of cranial nerve neurostimulator electrode array and pulse generator; HCPCS device code C1827 referenced for generator device.