CurrentPremera BluecrossPolicy N/A

Responsive Neurostimulation for Focal Epilepsy

Customize your policy alerts

Sign up for all Premera Bluecross policy alerts

Know when Premera Bluecross releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy describes when responsive neurostimulation may be considered medically necessary for individuals with refractory focal epilepsy and identifies documentation and billing information for providers. RNS is investigational for all other indications.

Policy Summary

PayerPremera Bluecross

PolicyResponsive Neurostimulation for Focal Epilepsy

Policy CodePolicy N/A

Change TypeAdministrative related-policy update

Effective DateOct 14, 2026

Last ReviewJun 22, 2026

Next Review DateN/A

Key ActionSubmit records documenting the diagnosis, seizure history, testing identifying one or two well-localized seizure foci, failed prior medical therapy, and contraindications to focal resective surgery.

SourceLink

POLICY UPDATE CHANGES

The Related Policies section was updated to identify policy 7.01.609 Deep Brain Stimulation as replacing policy 7.01.63.

18+Minimum age for medically necessary RNS

≥3/monthRequired disabling seizure frequency

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentPremera BluecrossPolicy N/A

Responsive Neurostimulation for Focal Epilepsy

Customize your policy alerts

Sign up for all Premera Bluecross policy alerts

Know when Premera Bluecross releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerPremera Bluecross

PolicyResponsive Neurostimulation for Focal Epilepsy

Policy CodePolicy N/A

Change TypeAdministrative related-policy update

Effective DateOct 14, 2026

Last ReviewJun 22, 2026

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

The Related Policies section was updated to identify policy 7.01.609 Deep Brain Stimulation as replacing policy 7.01.63.

18+Minimum age for medically necessary RNS

≥3/monthRequired disabling seizure frequency

>2Failed antiepileptic medications

1 or 2Well-localized seizure foci required

Medical Necessity and Coverage Criteria

Medically necessary RNS

RNS may be considered medically necessary when all of the following criteria are met:

title":"Medically necessary RNS"},{

Investigational or otherwise unqualified use

RNS is considered investigational for all other indications.

Investigational or otherwise unqualified use: The requested RNS use is for an indication other than the medically necessary use in an adult with refractory focal epilepsy who meets all applicable coverage criteria.

Coverage is not established under this policy when any required criterion is not met.

RNS device placement is contraindicated when the individual has three or more specific seizure foci, primary generalized epilepsy, or a rapidly progressive neurologic disorder. All listed contraindications must be absent for coverage consideration.

This policy does not address use of RNS exclusively for seizure monitoring. Although the system can provide continuous electrocorticographic seizure-mapping data, monitoring-only use is outside the scope of the policy criteria described here.

RNS is considered investigational for all indications other than the specified medically necessary treatment of adults with refractory focal epilepsy who meet all applicable coverage criteria.

Coding and Coverage Parameters

CPT Codes Used in Conjunction with the RNS ProcedureCPT

61850	Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical.
61860	Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical.
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.
61864	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; each additional array (List separately in addition to primary procedure).
61885	Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array.
61886	Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays.
61889	Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s).
61891	Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s).

HCPCS Codes Used in Conjunction with the RNS ProcedureHCPCS

C1767	Generator, neurostimulator (implantable), nonrechargeable.
C1778	Lead, neurostimulator (implantable).
L8680	Implantable neurostimulator electrode, each.
L8686	Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension.
L8688	Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension.

FDA Product Codemixed

PFN	FDA product code for the NeuroPace RNS System

Minimum age

Minimum age18 years or older

PopulationIndividuals with focal epilepsy

Coverage contextRequired for RNS to be considered medically necessary

Well-localized seizure foci

Required number of fociOne or two well-localized seizure foci

Identification methodIdentified by EEG or other diagnostic testing

Seizure type

Documentation and Provider Requirements

Step Therapy

Document failed antiepileptic therapy

Document that the individual is refractory to medical therapy, defined as failure of more than two appropriate antiepileptic medications administered at therapeutic doses.

Documentation Required

Submit complete clinical records

Submit medical records documenting that medical necessity criteria are met. Include the diagnosis or condition; history and physical examination describing severity, including seizure history; EEG or other diagnostic testing identifying one or two well-localized seizure foci; prior medical therapy that has failed; and contraindications to focal resective epilepsy surgery.

Clinical Background

Responsive neurostimulation is used for focal epilepsy by monitoring electrocorticographic activity and delivering electrical stimulation when patterns associated with an impending seizure are detected. The system uses an implanted stimulator with one or two leads placed at seizure-onset locations. It may be considered for individuals with refractory focal epilepsy who have few treatment options and are not candidates for focal resective surgery; evidence described in the policy supports a modest reduction in seizure frequency in a subset of appropriately selected individuals.

Key Definitions

Electroencephalography (EEG)

TermElectroencephalography (EEG)

DefinitionA diagnostic test used to identify seizure activity and seizure foci

Policy useAn EEG or other diagnostic testing report identifies one or two well-localized seizure foci

Focal epilepsy

TermFocal epilepsy

DefinitionFocal seizures, formerly called partial seizures, arising from a discrete area of the brain

RNS contextRNS may be considered for individuals with focal epilepsy who meet all policy criteria

Policy Summary

PayerPremera Bluecross

PolicyResponsive Neurostimulation for Focal Epilepsy

Policy CodePolicy N/A

Change TypeAdministrative related-policy update

Effective DateOct 14, 2026

Last ReviewJun 22, 2026

Next Review DateN/A

SourceLink

On This Page

Disabling seizure frequency

Average frequencyThree or more disabling seizures per month

Measurement periodPrior three months

ExamplesMotor focal seizures, complex focal seizures, or secondary generalized seizures

Failed antiepileptic medications

Medications failedMore than two appropriate antiepileptic medications

Dose requirementMedications must have been administered at therapeutic doses

Clinical standardFailure must establish that the individual is refractory to medical therapy

Contraindicating seizure foci

Contraindicating thresholdThree or more specific seizure foci

EffectContraindication to RNS device placement

Permitted rangeOne or two well-localized seizure foci are within the covered criterion; three or more are not

FDA-approved minimum age

Minimum age18 years or older

FDA indicationAdjunctive therapy for individuals with partial onset seizures

Seizure statusThe individual must have frequent and disabling seizures

FDA-approved localized epileptogenic foci

Maximum number of fociNo more than two localized epileptogenic foci

Testing requirementDiagnostic testing must localize the epileptogenic foci

FDA-approved populationIndividuals with partial onset seizures

FDA-approved failed antiepileptic medications

Medications failedTwo or more antiepileptic medications

Treatment statusThe individual must be refractory to two or more antiepileptic medications

FDA contextThis requirement applies to the FDA-approved RNS population

FDA-approved disabling seizure frequency

Average frequencyThree or more disabling seizures per month

Measurement periodThree most recent months

Monthly minimumNo month may have fewer than two seizures

Avoid investigational indications

RNS is considered investigational for all indications other than the specified medically necessary use in adults with refractory focal epilepsy who meet all policy criteria. Confirm that the requested indication is covered before submitting the request.

Denial Risk

Verify all medical necessity criteria

Coverage may be denied when the individual is younger than 18, has more than two seizure foci, has primary generalized epilepsy, has a rapidly progressive neurologic disorder, or does not meet the required seizure-frequency, diagnostic, medication-refractoriness, or resective-surgery criteria.

Refractory to medical therapy

TermRefractory to medical therapy

DefinitionFailure of more than two appropriate antiepileptic medications administered at therapeutic doses

Coverage contextRefractory medical therapy is required for medically necessary RNS

Responsive neurostimulation

TermResponsive neurostimulation

DefinitionA treatment system that detects epileptiform patterns and delivers electrical stimulation to interrupt or prevent seizure activity

System componentsAn implanted stimulator uses one or two wires placed at locations where seizures start