Currentselect_healthPolicy CCP.1111

Laser interstitial thermal therapy (LITT) for drug-resistant epilepsy

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Defines Select Health of South Carolina's coverage stance and medical necessity criteria for MRI-guided laser interstitial thermal therapy to treat drug-resistant (medically intractable) epileptic seizures; applies to providers seeking coverage for members under Select Health plans.

Policy Summary

Payerselect_health

PolicyLaser interstitial thermal therapy (LITT) for drug-resistant epilepsy

Policy CodePolicy CCP.1111

Change TypeClinical criteria revised (2023)

Effective DateSep 1, 2024

Last ReviewJul 1, 2025

Next Review DateNov 1, 20269d

Key ActionObtain prior authorization documenting failure of ≥2 appropriately dosed antiepileptic medications, MRI suitability, and a well-defined epileptogenic focus accessible to LITT.

SourceLink

POLICY UPDATE CHANGES

In 2023 the medical necessity criteria were modified to reflect growing literature supporting LITT as a minimally invasive alternative to open surgery for focal drug-resistant epilepsy.

>=2Medication trials before LITT

57.8%Seizure-free rate (Chen 2023)

8.5%–19.8%Overall complication rate

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Currentselect_healthPolicy CCP.1111

Laser interstitial thermal therapy (LITT) for drug-resistant epilepsy

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Sign up for select_health Policy CCP.1111 alerts

Get alerted when Policy CCP.1111 changes without checking for updates manually.

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Policy Summary

Payerselect_health

PolicyLaser interstitial thermal therapy (LITT) for drug-resistant epilepsy

Policy CodePolicy CCP.1111

Change TypeClinical criteria revised (2023)

Effective DateSep 1, 2024

Last ReviewJul 1, 2025

Next Review DateNov 1, 20269d

Key ActionObtain prior authorization documenting failure of ≥2 appropriately dosed antiepileptic medications, MRI suitability, and a well-defined epileptogenic focus accessible to LITT.

SourceLink

POLICY UPDATE CHANGES

In 2023 the medical necessity criteria were modified to reflect growing literature supporting LITT as a minimally invasive alternative to open surgery for focal drug-resistant epilepsy.

>=2Medication trials before LITT

57.8%Seizure-free rate (Chen 2023)

8.5%–19.8%Overall complication rate

Coverage and Medical Necessity Criteria

Medically necessary (coverage criteria)

Covered when ALL of the following are met:

LITT Medical Necessity Criteria: Failure to respond to, or intolerance of, at least two appropriately dosed antiepileptic medications to control disabling seizures.>=2 medications

Document trials including doses, duration, and reason for discontinuation.

LITT Medical Necessity Criteria: No contraindications to magnetic resonance imaging.

Provide documentation demonstrating MRI compatibility (e.g., absence of incompatible implants or devices).

LITT Medical Necessity Criteria: Documentation of well-defined epileptogenic foci or critical pathways of seizure propagation accessible by laser interstitial thermal therapy.

Include imaging, EEG, and surgical consultation notes showing target location and accessibility to LITT.

LITT is excluded when the epileptogenic focus (or foci) or critical pathways of seizure propagation cannot be reliably identified or are not accessible to the laser approach. Additional contraindications include inability to undergo magnetic resonance imaging and medical contraindications to surgery (for example, unstable cardiac or respiratory conditions, anticoagulants that cannot be stopped, or bleeding diatheses).

Evidence from systematic reviews and nonrandomized studies shows that while LITT is generally safe and associated with fewer postoperative neurological deficits than open resection, it is less effective at achieving seizure freedom (Engel class I outcomes) in some comparisons. LITT may therefore be less appropriate than open resection for patients whose primary goal is maximal likelihood of long-term seizure freedom, particularly when open resection is technically feasible and the lesion is amenable to standard surgery.

LITT may still be considered for select adult or pediatric patients with accessible, focal temporal lobe lesions who accept a tradeoff of lower efficacy in exchange for potentially better cognitive outcomes, shorter hospital stay, and lower morbidity compared with open resection. Providers should weigh these effectiveness differences when counseling patients and documenting the rationale for choosing LITT over open surgery.

Coding

Provider Requirements and Prior Authorization

Prior Authorization

Prior authorization required to establish medical necessity

Prior authorization is required to establish that the member meets the LITT medical necessity criteria: failure to respond to or intolerance of at least two appropriately dosed antiepileptic medications, no contraindication to MRI, and documentation of a well-defined epileptogenic focus or seizure propagation pathway accessible by LITT.

Step Therapy

Medication step requirement: ≥2 antiepileptic medication trials

Patients must have trialed and failed (or been intolerant to) at least two appropriately dosed antiepileptic medications before LITT will be considered medically necessary.

Documentation Required

Background

Epilepsy is a disorder of recurrent seizures due to abnormal neuronal activity, affecting millions of people in the United States. Antiepileptic drug therapy controls seizures in approximately two-thirds of patients; those who remain symptomatic despite medications are considered to have drug-resistant (medically intractable) epilepsy and may be evaluated for surgical options.

Laser interstitial thermal therapy (LITT) is a minimally invasive, MRI-guided technique that delivers focused laser energy via an intracranial probe to thermally ablate target brain tissue under real-time imaging. Because it can spare adjacent tissue and is associated with shorter hospital stays and reduced morbidity compared with open resection, LITT is an option for carefully selected patients with well-defined, accessible epileptogenic foci.

Definitions

Laser interstitial thermal therapy (LITT) — definition and short description

DefinitionA minimally invasive surgical technique using magnetic resonance imaging (MRI) guidance to deliver focused laser energy via an intracranial probe to thermally ablate target brain tissue, with real‑time visualization of ablation.

Procedure detailsAccess via a 3–4 mm skull incision to insert a laser probe; MRI is used to guide probe placement and to visualize thermal ablation in real time.

Alternate namesAlso called laser‑induced interstitial thermotherapy, laser‑induced thermotherapy, interstitial laser therapy, or laser ablation.

Clinical roleMinimally invasive alternative to open resection for focal lesional epilepsy, especially in patients considered high‑risk for open surgery; open resection remains an option if ablation is ineffective.

Regulatory devicesFDA 510(k) clearances: Visualase thermal ablation system (2006) and NeuroBlate laser ablation system (2013).