It's now official - as of April 1, 2003 Medicare will cover DBS surgery
in all 50 states in the U.S.
Previously coverage was decided by the local Medicare carriers, and only
about half of the states' carriers would cover it.
Nationwide coverage happened because one individual - Barry Green - a PWP
from Texas filed a request for a national coverage decision in October
2001 and set the lengthy decision process in motion.
CONGRATULATIONS BARRY!
Linda Herman

Excerpts from the coverage decision - with criteria for coverage and
requirements for providers  and facilities performing the surgery  below
:

"Program Memorandum Department of Health & Human Services (DHHS)
Intermediaries/Carriers
Centers for Medicare &
Medicaid Services (CMS)
Transmittal AB-03-023
Date: FEBRUARY 14, 2003
CHANGE REQUEST 2553
SUBJECT: Deep Brain Stimulation for Essential Tremor and Parkinson’s
Disease
Deep brain stimulation (DBS) refers to high-frequency electrical
stimulation of anatomic regions deep within the brain utilizing
neurosurgically implanted electrodes. These DBS electrodes are
stereotactically placed within targeted nuclei on one (unilateral) or
both (bilateral) sides of the brain.There are currently three targets for
DBS -- the thalamic ventralis intermedius nucleus (VIM), subthalamic
nucleus (STN) and globus pallidus interna (GPi).
 For patients who become unresponsive to medical treatments and/or have
intolerable side effects from medications, DBS for symptom relief may be
considered.

Effective on or after April 1, 2003, Medicare will cover unilateral or
bilateral thalamic VIM DBS for the treatment of ET and/or Parkinsonian
tremor and unilateral or bilateral STN or GPi DBS for the treatment of PD
only under the following conditions:

For STN or GPi DBS to be considered reasonable and necessary, patients
must meet all of the following criteria:
a. Diagnosis of PD based on the presence of at least 2 cardinal PD
features (tremor,
rigidity or bradykinesia).
b. Advanced idiopathic PD as determined by the use of Hoehn and Yahr
stage or
Unified Parkinson’s Disease Rating Scale (UPDRS) part III motor subscale.
c. L-dopa responsive with clearly defined “on” periods.
d. Persistent disabling Parkinson’s symptoms or drug side effects (e.g.,
dyskinesias,
motor fluctuations, or disabling “off” periods) despite optimal medical
therapy.
e. Willingness and ability to cooperate during conscious operative
procedure, as well as
during post-surgical evaluations, adjustments of medications and
stimulator settings.

DBS is not reasonable and necessary and is not covered for ET or PD
patients with any of thefollowing:
1. Non-idiopathic Parkinson’s disease or “Parkinson’s Plus” syndromes.
2. Cognitive impairment, dementia or depression which would be worsened
by or would
interfere with the patient’s ability to benefit from DBS.
3. Current psychosis, alcohol abuse or other drug abuse.
4. Structural lesions such as basal ganglionic stroke, tumor or vascular
malformation as
etiology of the movement disorder.
5. Previous movement disorder surgery within the affected basal ganglion.
6. Significant medical, surgical, neurologic or orthopedic co-morbidities
contraindicating DBS surgery or stimulation.

***Patients who undergo DBS implantation should not be exposed to
diathermy (deep heat treatment including shortwave diathermy, microwave
diathermy and ultrasound diathermy) or any type of MRI which may
adversely affect the DBS system or adversely affect the brain around the
implanted electrodes.

For DBS lead implantation to be considered reasonable and necessary,
providers and facilities must meet all of the following criteria:
1. Neurosurgeons must: (a) be properly trained in the procedure; (b) have
experience with the surgical management of movement disorders, including
DBS therapy; and (c) have
experience performing stereotactic neurosurgical procedures.
2. Operative teams must have training and experience with DBS systems,
including
knowledge of anatomical and neurophysiological characteristics for
localizing the targeted nucleus, surgical and/or implantation techniques
for the DBS system, and operational and functional characteristics of the
device.
3. Physicians specializing in movement disorders must be involved in both
patient selection and post-procedure care.
4. Hospital medical centers must have: (a) brain imaging equipment (MRI
and/or CT) for preoperative stereotactic localization and targeting of
the surgical site(s); (b) operating rooms with all necessary equipment
for stereotactic surgery; and (c) support services necessary for care of
patients undergoing this procedure and any potential complications
arising intraoperatively or postoperatively.

full text at:
http://www.cms.gov/manuals/pm_trans/AB03023.pdf

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