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    v1.0.30
    OpenPayerPolicy UpdatesNeurology/NeurosurgeryPremera nTMS Mapping Coverage Update | OpenPayer
    Ask Trek AI about this page
    ModifiedPremera Blue Cross of WashingtonPolicy N/A

    Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping

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    Coverage policy for navigated transcranial magnetic stimulation used for preoperative motor or language mapping before surgery for brain tumors or other intracranial lesions near eloquent cortex.

    Policy Summary
    PayerPremera Blue Cross of Washington
    PolicyNavigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping
    Policy CodePolicy N/A
    Change TypeModified
    Effective DateFeb 5, 2027
    Next Review DateN/A
    Key ActionExpect denial for navigated nTMS requested for preoperative motor or language mapping because the service is considered investigational.
    SourceLink
    POLICY UPDATE CHANGES

    A new policy classifies navigated repetitive transcranial magnetic stimulation for preoperative motor or language mapping as investigational.

    InvestigationalCoverage status
    64999Listed CPT code
    87%-100%Language mapping sensitivity
    13%-67%Language mapping specificity

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    Coverage Criteria

    Preoperative motor or language mapping

    Navigated transcranial magnetic stimulation is considered investigational.

    Investigational preoperative nTMS: Navigated transcranial magnetic stimulation (nTMS) of the brain using an FDA-cleared device and modality is considered investigational for preoperative motor or language mapping in individuals undergoing surgery for brain tumors or other intracranial lesions near eloquent cortex, including systems such as Nexstim Navigated Brain Stimulation Systems.

    This determination applies to both preoperative motor mapping and preoperative language mapping.

    Investigational use

    The policy considers the following use investigational.

    Investigational presurgical nTMS use: Navigated repetitive transcranial magnetic stimulation (nTMS) of the brain using an FDA-cleared device and modality is considered investigational for preoperative motor or language mapping in individuals undergoing surgery for brain tumors or other intracranial lesions near eloquent cortex.

    No positive coverage criteria are stated for this investigational use.

    Coding

    Investigational CPT CodeCPTExperimental
    64999Unlisted procedure, nervous system

    Provider Actions

    Denial Risk

    Expect denial for preoperative nTMS mapping

    Requests for navigated transcranial magnetic stimulation of the brain using an FDA-cleared device and modality for preoperative motor or language mapping are subject to denial because the service is considered investigational. This applies to individuals undergoing surgery for brain tumors or other intracranial lesions near eloquent cortex, including use of systems such as Nexstim Navigated Brain Stimulation Systems.

    Denial Risk

    Presurgical mapping is investigational

    Coverage is at risk of denial when navigated repetitive transcranial magnetic stimulation is requested for preoperative motor or language mapping. The policy considers this use investigational for individuals undergoing surgery for brain tumors or other intracranial lesions near eloquent cortex.

    Background

    Navigated transcranial magnetic stimulation (nTMS) is a noninvasive preoperative technique that combines transcranial magnetic stimulation with MRI-based neuronavigation to create functional maps of motor- and language-related cortical areas. It may support surgical planning for brain tumors or other intracranial lesions near eloquent cortex; intraoperative direct cortical or direct electrical stimulation may be used to confirm functional boundaries.

    Definitions

    Navigated transcranial magnetic stimulation (nTMS)
    ModalityA noninvasive diagnostic and presurgical planning modality using navigated transcranial magnetic stimulation (nTMS).
    Motor mappingMaps the primary motor cortex for preprocedural planning before brain surgery.
    Language mappingWhen used with NEXSPEECH, localizes cortical areas that do not contain essential speech function to support presurgical planning.
    Intraoperative useThe device is not intended for use during a surgical procedure; NEXSPEECH localization is intended to be verified by direct cortical stimulation intraoperatively.
    510(k) clearance
    PathwayFDA 510(k) clearance is a marketing clearance pathway for diagnostic preprocedural mapping uses under the evoked response electrical stimulator classification.
    Policy Summary
    PayerPremera Blue Cross of Washington
    PolicyNavigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping
    Policy CodePolicy N/A
    Change TypeModified
    Effective DateFeb 5, 2027
    Next Review DateN/A
    Key ActionExpect denial for navigated nTMS requested for preoperative motor or language mapping because the service is considered investigational.
    SourceLink
    On This Page
    Coverage CriteriaCodingProvider ActionsBackgroundDefinitions
    Nexstim eXimia Navigated Brain Stimulation SystemReceived 510(k) clearance K091457 in December 2009 for noninvasive mapping of the primary motor cortex for preprocedural planning.
    Nexstim Navigated Brain Stimulation System 4Received 510(k) clearance K112881 in May 2012 for noninvasive mapping of the primary motor cortex for preprocedural planning.
    NBS System 4 with NEXSPEECHReceived 510(k) clearance K112881; NEXSPEECH was cleared to localize cortical areas that do not contain essential speech function for presurgical planning.
    NBS 6Although currently marketed for diagnostic presurgical mapping, no additional FDA 510(k) clearances for diagnostic brain-mapping indications were identified beyond the predicate clearances.