CurrentUnitedHealthcarePolicy 2026T0321LL

Deep Brain and Cortical Stimulation

UnitedHealthcare Commercial and Individual Exchange medical policy defining coverage rationale, medical necessity, and not-medically-necessary determinations for deep brain stimulation (DBS) and responsive cortical stimulation (RCS)/responsive neurostimulation (RNS). Includes applicable CPT/HCPCS codes, background, evidence summary, FDA references, and revision history.

Policy Summary

PayerUnitedHealthcare

PolicyDeep Brain and Cortical Stimulation

Policy CodePolicy 2026T0321LL

Change TypeClarified not medically necessary for OCD and other non‑listed indications

Effective DateFeb 1, 2026

Next Review Date

Key ActionMedical records documentation may be required to assess whether the member meets the clinical criteria for coverage; reference the Medical Records Documentation Used for Reviews guideline and InterQual criteria for specific requirements.

SourceLink

POLICY UPDATE CHANGES

Added language clarifying 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 as proven and medically necessary.

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

4Proven Indications (DBS)

1Proven Indications (RCS)

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Coverage Summary & Scope

UnitedHealthcare Medical Policy 2026T0321LL (Effective 2026-02-01) addresses coverage for Deep brain stimulation (DBS) and Responsive cortical stimulation (RNS/RCS) for UnitedHealthcare Commercial and Individual Exchange plans. The policy's stance is mixed: DBS is proven and medically necessary for dystonia, essential tremor, Parkinson disease, and refractory partial/focal epilepsy; responsive cortical stimulation is proven and medically necessary for refractory partial or focal seizure disorder. Deep brain and cortical stimulation (including RNS) are unproven and not medically necessary for obsessive-compulsive disorder (OCD) and for all other indications not listed as proven. Status: CURRENT.

Policy metadata

policy_number2026T0321LL

effective_dateFebruary 1, 2026

last_reviewFebruary 1, 2026

payerUnitedHealthcare

subjectDeep brain and cortical stimulation

Medical Necessity — Covered and Excluded Indications

Proven and Medically Necessary Indications

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

Proven and Medically Necessary Indications for DBS

Dystonia
Essential tremor
Parkinson disease
Refractory epilepsy (partial or focal): Refractory epilepsy for a partial or focal seizure disorder

Responsive Cortical Stimulation (RCS/RNS) - Proven and Medically Necessary

Applicable Procedure and Device Codes

Applicable CPT (procedure) codes (reference list)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	Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site; each additional array.
61867	Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site with intraoperative microelectrode recording; first array.
61868	Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site with intraoperative microelectrode recording; each additional array.
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; with connection to 2 or more electrode arrays.
61889	Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, 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).

1–10 of 11

1/2

Applicable HCPCS / Implantable device codesHCPCS

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.
L8688	Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension.

Provider Actions & Administrative Requirements

Prior Authorization

Preauthorization reference

Coverage determinations may require preauthorization and should reference member-specific benefit plan documents. UnitedHealthcare may use InterQual® criteria (InterQual® CP: Procedures, Stereotactic Introduction, Subcortical or Cortical Electrodes) to assist in administering benefits and assessing clinical criteria for deep brain and responsive cortical stimulation.

Documentation Required

Medical records required to assess clinical criteria

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage. Refer to the Medical Records Documentation Used for Reviews guideline and the InterQual® clinical criteria (InterQual® CP: Procedures, Stereotactic Introduction, Subcortical or Cortical Electrodes) for specific documentation and patient selection requirements.

Background, Evidence, and Definitions

Deep brain stimulation (DBS) delivers electrical pulses to specific subcortical brain targets (for example, internal globus pallidus, subthalamic nucleus, ventral intermediate nucleus of the thalamus) via surgically implanted leads to interrupt pathways responsible for abnormal movements. The DBS system components include an implantable pulse generator or neurostimulator (approximately the size of a stopwatch), implantable leads with electrodes, subcutaneous extension wires, and connecting hardware; DBS is reversible and adjustable compared with ablative procedures.

Responsive cortical stimulation (RNS/RCS) is a closed-loop implantable neurostimulator intended to detect abnormal electrophysiologic signals that precede seizures and deliver stimulation in response to normalize brain activity and prevent seizure development. The RNS system includes a skull‑placed neurostimulator and intracranial leads positioned in the seizure‑originating brain areas and supports remote data transmission and clinician programming.

Evidence summary: Medical necessity clinical criteria reference the InterQual® CP: Procedures, Stereotactic Introduction, Subcortical or Cortical Electrodes for patient selection and coverage determinations.

Systematic reviews and randomized trials have been summarized in the policy (references 2014–2025). Multiple systematic reviews and randomized, sham‑controlled trials have evaluated DBS for obsessive‑compulsive disorder (OCD) and other indications; recent individual‑participant data meta‑analysis and systematic reviews (2022–2025) report promising but low‑quality evidence for OCD with limitations including small sample sizes, methodological heterogeneity, and safety/long‑term outcome uncertainties.

Interpreting evidence: Because of the available evidence and cited reviews/trials, the policy deems DBS and RNS medically necessary for specific neurologic indications listed but considers DBS/RNS unproven and not medically necessary for OCD and other unlisted indications pending larger, high‑quality studies.

Revision History

02/01/2026material_changeLatest

02/01/2026supporting_information_updatedLatest

Supporting information updated: Clinical Evidence, FDA, and References sections were updated to reflect the most current information.

Term	Definition
Deep brain stimulation (DBS)	Electrical pulses delivered to select brain areas via surgically implanted electrodes; reversible and adjustable neuromodulation therapy.
Responsive cortical stimulation (RNS/RCS)	Closed-loop implantable neurostimulator that detects abnormal brain signals and delivers stimulation in response to prevent seizures.