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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 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn