Deep Brain and Cortical Stimulation (for New Jersey Only)
Policy governing medical necessity and coverage of deep brain stimulation (DBS) and responsive cortical stimulation (RNS) for members in New Jersey, including covered indications, unproven indications, coding references, and documentation expectations.
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.
Added language clarifying medical records documentation requirements used for reviews, including that documentation may be required to assess whether the member meets clinical criteria and that documentation does not guarantee coverage.
Removed notation that CPT codes 61889 and 61891 are not on the State of New Jersey Medicaid Fee Schedule and therefore may not be covered by the State of New Jersey Medicaid Program.
Updated supporting information, clinical evidence, and references sections to reflect the most current information.
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