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.

CurrentRegencePolicy N/A

Deep Brain Stimulation

Customize your policy alerts

Sign up for all regence policy alerts

Know when regence 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 governs coverage of unilateral or bilateral deep brain stimulation, including medical-necessity criteria and documentation requirements for neurologic conditions.

Policy Summary

PayerRegence

PolicyDeep Brain Stimulation

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJuly 1, 2026

Last ReviewMay 1, 2026

Next Review DateMarch 1, 2027

Key ActionSubmit history and physical or chart notes, multidisciplinary evaluations, the DBS indication, the brain region to be stimulated, any condition anticipated to require repeat MRI, and the DBS device name.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Covered conditions with sufficient evidence for selected patients

18+Minimum age for FDA-approved DBS epilepsy indication

3+Antiepileptic medications for refractory epilepsy indication

15 minInitial programming interval

Coverage Criteria

Medical Necessity Framework

DBS may be considered medically necessary when all of the following requirements are satisfied:

Medical necessity framework: A multidisciplinary evaluation confirms both the medical intractability of the individual's symptoms and the potential value of deep brain stimulation (DBS).

Policy criteria: Both criteria A and B are met, with criterion A satisfied by one of the alternatives specified in the policy.

The detailed alternatives for criteria A and B are not included in the available policy excerpt.

Medically Necessary

Covered when all applicable policy requirements are met:

Covered DBS indications: The individual has symptoms related to Parkinson's disease, essential tremor, or primary dystonia.

Coding and Billing

CODESCPT

61850	Twist or burr hole(s) for implantation of neurostimulator electrode(s), cortical
61860	Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical
61863	Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of neurostimulator 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 for stereotactic implantation of neurostimulator 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)
61867	Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of neurostimulator array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array
61868	Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of neurostimulator array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with 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 two or more electrode arrays

Deep Brain Stimulation Procedure and Neurostimulator Management CodesCPT

61867	Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of neurostimulator array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array
61868	Twist drill, burr hole, craniotomy, or craniectomy for stereotactic implantation of neurostimulator array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with 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 two or more electrode arrays
61888	Revision or removal of cranial neurostimulator pulse generator or receiver
95970	Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve neurostimulator pulse generator/transmitter, without programming
95983	Electronic analysis of implanted neurostimulator pulse generator/transmitter by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
95984	With brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure).

Provider Documentation and Review Risks

Denial Risk

Medical-Necessity Criteria Must Be Supported

Submit clinical documentation sufficient to establish that a multidisciplinary evaluation confirmed both the medical intractability of the individual's symptoms and the potential value of DBS, along with the applicable policy criteria. If the evaluation does not support these findings, DBS may be denied as not meeting medical-necessity requirements.

Denial Risk

Covered Indication Criteria Not Met

DBS is considered not medically necessary for symptoms related to Parkinson's disease, essential tremor, or primary dystonias when the policy criteria are not met. Verify that the applicable indication-specific criteria are satisfied before requesting authorization.

Applicable indications: Parkinson's disease, essential tremor, or primary dystonias
When policy criteria are not met, DBS is not clinically appropriate and may be denied

Background

Deep brain stimulation (DBS) is a stereotactic procedure that places electrodes in selected brain targets, including the hypothalamus, thalamus, globus pallidus, or subthalamic nucleus. The system may use temporary stimulation to validate effectiveness before permanent implantation of subcutaneous leads and a programmable neurostimulator. Evidence supports improved net health outcomes in selected patients with Parkinson disease, essential tremor, or primary dystonias when the applicable policy criteria are met.

Definitions

Deep brain stimulation (DBS)

ProcedureStereotactic placement of electrodes into the brain

Principal targetHypothalamus, thalamus, globus pallidus, or subthalamic nucleus (STN)

AbbreviationDBS means deep brain stimulation

Dystonia

Disorder typeNeurological movement disorder

Characteristic featureInvoluntary muscle contractions

EffectForces body parts into abnormal, contorted, and painful movements or postures

Policy Summary

PayerRegence

PolicyDeep Brain Stimulation

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJuly 1, 2026

Last ReviewMay 1, 2026

Next Review DateMarch 1, 2027

SourceLink

On This Page

Required evaluation and criteria: A multidisciplinary evaluation confirms medically intractable symptoms and the potential value of DBS, and the applicable policy criteria are met.

Coverage may include unilateral or bilateral DBS, including revision(s) or replacement(s).

Not Medically Necessary

DBS is not medically necessary when:

Covered indication criteria not met: The individual has symptoms related to Parkinson's disease, essential tremor, or primary dystonia, but the applicable policy criteria are not met.

DBS is not clinically appropriate for these indications when criteria are not met.

Investigational

DBS is investigational when:

Other indications: DBS is requested for an indication other than Parkinson's disease, essential tremor, or primary dystonia, and the applicable policy criteria are not met.

The policy states that there is insufficient research to determine the safety and effectiveness of DBS for other conditions.

Investigational indications: DBS is considered investigational when applicable policy criteria are not met, including requests for cerebral palsy; chronic pain such as nociceptive or neuropathic pain; cognitive decline or dementia due to Parkinson disease; epilepsy or intractable seizures; Huntington disease; multiple sclerosis; neuropsychiatric applications such as anorexia nervosa, anxiety, bipolar disorder, depression, obsessive-compulsive disorder, schizophrenia, or Tourette syndrome; Alzheimer disease; other movement disorders; post-traumatic tremor; tardive dyskinesia or tardive dystonia; and traumatic brain injury.

Not clinically appropriate: DBS is not medically necessary for individuals with symptoms related to Parkinson disease, essential tremor, or primary dystonia when the applicable policy criteria are not met.

CPT neurostimulator analysis and programming codesCPT

61888	Generator/transmitter
95970	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming
95983	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
95984	With brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure).

HCPCS implantable neurostimulator generatorHCPCS

C1820

Generator, neurostimulator (implantable), with rechargeable battery and charging system.

HCPCS external electrical stimulator suppliesHCPCS

L8678

Electrical stimulator supplies (external) for use with implantable neurostimulator, per month.

CODESmixed

95983	Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
95984	With brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)
C1820	Generator, neurostimulator (implantable), with rechargeable battery and charging system
L8678	Electrical stimulator supplies (external) for use with implantable neurostimulator, per month.
L8679	Implantable neurostimulator, pulse generator, any type.
L8680	Implantable neurostimulator electrode, each.
L8681	Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only.
L8682	Implantable neurostimulator radiofrequency receiver.

CPT Programming CodeCPT

95984

With brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)

HCPCS Neurostimulator Devices and SuppliesHCPCS

C1820	Generator, neurostimulator (implantable), with rechargeable battery and charging system
L8678	Electrical stimulator supplies (external) for use with implantable neurostimulator, per month
L8679	Implantable neurostimulator, pulse generator, any type
L8680	Implantable neurostimulator electrode, each
L8681	Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
L8682	Implantable neurostimulator radiofrequency receiver
L8683	Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8685	Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686	Implantable neurostimulator pulse generator, single array, nonrechargeable

Yale-Brown Obsessive Compulsive Scale severity

Severe illness thresholdY-BOCS score of 24 or more out of 40

Defined severe OCD rangeY-BOCS score from 24 to 31

ScaleYale-Brown Obsessive Compulsive Scale (Y-BOCS)

OCD response

Therapeutic responseAt least a 35% reduction in Y-BOCS score from pretreatment baseline

Partial responseA 25% to 35% reduction in Y-BOCS score

Assessment measureYale-Brown Obsessive Compulsive Scale (Y-BOCS)

OCD treatment resistance

Treatment-resistant OCDOCD persisting despite high-dose selective serotonin reuptake inhibitor (SSRI) therapy and augmentation strategies

Minimum therapy durationAt least 12 weeks

Treatment contextHigh-dose SSRI therapy with augmentation strategies

Initial brain neurostimulator programming interval

Programming code95983

Initial intervalFirst 15 minutes

Required settingFace-to-face time with the physician or other qualified health care professional

Documentation Required

Required Documentation

It is critical to submit all information needed to determine whether the policy criteria are met. Missing documentation could impact the review and decision outcome.

History and physical/chart notes
Multidisciplinary evaluations
Indication for DBS
Brain region to be stimulated
Condition anticipated to require repeat MRI, if present
Name of DBS device

Denial Risk

Other Indications May Be Investigational

DBS is considered investigational for indications that do not meet the policy criteria, including the conditions listed below. Confirm that the requested indication satisfies the policy criteria before submitting the request.

Cerebral palsy; chronic pain, including nociceptive or neuropathic pain
Cognitive decline or dementia due to Parkinson's disease; epilepsy or intractable seizures; Huntington's disease; multiple sclerosis
Neuropsychiatric applications, including anorexia nervosa, anxiety, bipolar disorder, depression, obsessive-compulsive disorder, schizophrenia, Tourette syndrome, and Alzheimer's disease
Other movement disorders; post-traumatic tremor; tardive dyskinesia and tardive dystonia; traumatic brain injury (TBI)

Denial Risk

Investigational Status for Other Indications

There is not enough research to determine the safety and effectiveness of DBS for other conditions. DBS is considered investigational for all other indications when policy criteria are not met.

Primary dystonia

DefinitionDystonia occurring as the only symptom

Associated pathologyNot associated with other pathology

ClassificationA form of dystonia classified by cause

Secondary dystonia

DefinitionDystonia brought on by an inciting event

Examples of causesStroke, trauma, or drugs

Drug-induced formTardive dystonia is a form of drug-induced secondary dystonia

Tardive dyskinesia and tardive dystonia (TDD)

DefinitionSevere side effects of dopamine-blocking agents

Medication contextParticularly associated with antipsychotics

Evidence-review characterizationTreatment-resistant tardive dyskinesia and/or tardive dystonia

Drug-resistant epilepsy

DefinitionEpilepsy that does not respond to pharmacologic therapy

Medication contextApproximately one-third of patients do not respond to anti-epileptic drugs

Related termPatients who do not respond to anti-epileptic drugs are considered to have drug-resistant epilepsy

Humanitarian Device Exemption (HDE)

FDA pathwayHumanitarian Device Exemption (HDE)

Population criterionAvailable for conditions affecting fewer than 4,000 Americans per year

Evidence standardRequires probable benefit rather than definitive evidence of efficacy

Severe obsessive-compulsive disorder

Severity measureYale-Brown Obsessive Compulsive Scale (Y-BOCS)

Severe OCD rangeY-BOCS score from 24 to 31

Severe illness thresholdA score of 24 or more out of 40 indicates severe illness

OCD treatment response

Therapeutic responseAt least a 35% reduction in Y-BOCS score

Partial responseA 25% to 35% reduction in Y-BOCS score

Outcome measureYale-Brown Obsessive Compulsive Scale (Y-BOCS)

Treatment-resistant OCD

DefinitionPersistence of OCD despite treatment

Medication requirementAt least 12 weeks of high-dose selective serotonin reuptake inhibitor (SSRI) therapy

Augmentation requirementAugmentation strategies are included in the treatment-resistance definition