Modifiedsierra health and lifePolicy 2026T0321LL

Deep Brain and Cortical Stimulation

Medical policy governing use and coverage criteria for deep brain stimulation (DBS) and responsive cortical stimulation (RNS) for UnitedHealthcare Commercial and Individual Exchange members.

Policy Summary

Payersierra health and life

PolicyDeep Brain and Cortical Stimulation

Policy CodePolicy 2026T0321LL

Change TypeClarified non‑coverage for OCD and other non‑proven indicationsupdated references

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionPrior authorization required and requests for DBS/RNS for OCD or other non‑proven indications should be reviewed as not medically necessary per the updated policy.

SourceLink

POLICY UPDATE CHANGES

Added language to clarify deep brain stimulation and/or cortical stimulation are unproven and not medically necessary for treating obsessive-compulsive disorder (OCD) and all other indications not listed in the policy as proven and medically necessary.

Updated Clinical Evidence, FDA, and References sections to reflect the most current information.

4indications listed as proven and medically necessary

1device specifically named (RNS System)

9CPT/HCPCS code groups started in policy

344studies in systematic review (individuals)

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Coverage Criteria for Deep Brain and Cortical Stimulation

DBS - Medically Necessary Indications

Deep brain stimulation is proven and medically necessary for the following indications:

DBS proven indications: Dystonia; Essential tremor; Parkinson disease; Refractory epilepsy for a partial or focal seizure disorder

Listed as proven and medically necessary in policy.

Responsive Cortical Stimulation - Medically Necessary Indications

Responsive cortical stimulation coverage stance:

RNS proven indication: Refractory partial or focal seizure disorder

RNS (responsive cortical stimulation) is stated as proven and medically necessary for refractory partial or focal seizure disorder.

Unproven / Not Medically Necessary

Unproven / Not medically necessary:

Unproven indications: Deep brain stimulation and/or cortical stimulation for treating obsessive-compulsive disorder and all other indications; Responsive cortical stimulation for treating all other indications

Listed as unproven and not medically necessary due to insufficient evidence of efficacy.

Coverage Rationale and Evidence

Coverage stance based on policy revisions and guideline recommendations

Not medically necessary for OCD and other non‑proven indications: Deep brain stimulation and/or cortical stimulation are unproven and not medically necessary for treating obsessive‑compulsive disorder (OCD) and all other indications not listed in the policy as proven and medically necessary.

Policy revision 02/01/2026 added explicit non‑coverage language.

Exceptions and evidence: Guideline-level evidence exists for bilateral subthalamic nucleus (level I) and bilateral nucleus accumbens (level II) DBS in medically refractory OCD per an evidence review, but the overall body of evidence is limited and additional research is needed; NICE recommends use only in research settings with multidisciplinary selection and specialized centers.

These evidence points inform a cautious stance; despite some level I/II evidence, policy explicitly clarifies non‑coverage for OCD and other non‑proven indications.

Deep brain stimulation (DBS) and cortical stimulation for obsessive-compulsive disorder (OCD) and for any indications not listed elsewhere in this policy are considered unproven and not medically necessary due to insufficient evidence of efficacy.

The policy was revised effective 02/01/2026 to explicitly state that deep brain stimulation and/or cortical stimulation are unproven and not medically necessary for treating obsessive‑compulsive disorder (OCD) and all other indications not listed in the policy as proven and medically necessary, reflecting an updated coverage rationale and supporting information.

Because this language classifies these indications as unproven, requests for DBS or cortical stimulation to treat OCD or other non‑proven conditions should be evaluated as not medically necessary under this policy.

Responsive cortical stimulation (RNS) is considered medically necessary only for the proven indication of refractory partial or focal seizure disorder; using RNS for any other indication is not medically necessary.

Policy text added on 02/01/2026 clarifies the payer stance that deep brain stimulation and/or cortical stimulation are unproven and not medically necessary for OCD and any other indications not identified as proven and medically necessary in this document. This revision also updated the supporting Clinical Evidence, FDA, and References sections to reflect current information.

Providers should note that the clarified language increases the likelihood of a not medically necessary determination for requests to use DBS or cortical stimulation for OCD or other non‑listed indications.

Procedure, Device, and Product Codes

Applicable CPT/Procedure Codes (part 1)CPT

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; first array.
61864	…each additional array (List separately in addition to primary procedure).
61867	…with use of intraoperative microelectrode recording; first array.
61868	…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.

Applicable CPT/HCPCS Codes (part 2 and device codes)mixed

No codes listed

Applicable CPT/HCPCS Codes (part 2 and device codes)mixed

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).
64999	Unlisted procedure, nervous system
L8679	Implantable neurostimulator, pulse generator, any type.
L8680	Implantable neurostimulator electrode, each.
L8682	Implantable neurostimulator radiofrequency receiver.
L8685	Implantable neurostimulator pulse generator, single array, rechargeable, includes extension.
L8686	Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension.
L8687	Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension.

1–10 of 11

1/2

Applicable CPT/Procedure Codes (part 1)CPT

No codes listed

FDA device product codes for DBSmixed

MHY	FDA product code referenced for DBS devices
NHL	FDA product code referenced for DBS devices
OLM	FDA product code referenced for DBS devices
OLX	FDA product code referenced for DBS devices

FDA device product codes for responsive cortical stimulationmixed

No codes listed

FDA device product codes for responsive cortical stimulationmixed

PFN	FDA product code referenced for responsive cortical devices

FDA device product codes for DBSmixed

No codes listed

Response threshold

Response threshold>= 35% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score

Evidence sourceDefined in systematic review by Mar-Barrutia et al. (2021) as the response cutoff used across included studies

Use in reportingApplied to classify short-term and long-term responders in pooled DBS studies (short-term response 60.6%, long-term 70.7%)

Prior Authorization, Documentation, and Provider Guidance

Note

Applicable codes and benefit caveat

The following procedure and diagnosis codes are provided for reference only. Inclusion of a code does not imply coverage or guarantee payment; benefit determination is based on the member's specific plan and applicable laws.

See code table in the Applicable Codes section for CPT and HCPCS/L-codes commonly reported with cortical and deep brain stimulation procedures. Listing is not exhaustive and does not confirm coverage.

Prior Authorization

Prior authorization and review

Prior authorization is required. Requests for DBS or responsive cortical stimulation for obsessive-compulsive disorder (OCD) or for indications not proven medically necessary will be reviewed and are routinely denied unless clear, contemporaneous documentation supports enrollment in an approved clinical trial or other research context.

Prior authorization required for proposed implantation and generator procedures.
If the request is for OCD or any indication not listed as proven and medically necessary, include documentation of investigational status or research trial enrollment.

Background and Scope

Deep brain stimulation delivers electrical pulses to targeted brain regions via implanted electrodes; it is a reversible and adjustable neuromodulation therapy used for several evidence‑supported movement and seizure disorders. Responsive cortical stimulation is a closed‑loop system that detects abnormal pre‑seizure electrical activity and delivers stimulation to prevent seizures. The policy update clarifying non‑coverage for OCD and other non‑proven indications does not change the mechanism of these therapies but reflects the current evidence assessment and payer coverage stance.

Definitions and Terms

Deep Brain Stimulation (DBS) definition

DefinitionSurgically implanted electrodes deliver electrical pulses to selected brain areas (e.g., globus pallidus interna, subthalamic nucleus, ventral intermediate nucleus of the thalamus) via a pulse generator; reversible and adjustable alternative to ablation

ComponentsImplantable pulse generator/neurostimulator, implantable lead with electrodes, connecting wire/extension

Typical implantation sitesInternal globus pallidus interna, subthalamic nucleus, ventral intermediate nucleus of the thalamus

Responsive Cortical Stimulation (RNS) definition

DefinitionClosed-loop implantable neurostimulator system (RNS System) that detects abnormal pre-seizure electrical signals and delivers responsive stimulation via a skull‑mounted neurostimulator and leads placed at seizure foci

Device example

Policy Revision History

2026-02-01policy_revisionLatest

Added explicit language clarifying that deep brain stimulation and/or cortical stimulation are unproven and not medically necessary for treating obsessive-compulsive disorder (OCD) and all other indications not listed in the policy as proven and medically necessary; updated Clinical Evidence, FDA, and References sections; archived prior policy version 2026T0321KK.