Insurance Coverage

1. In which states is there Medicare coverage for the Neuravive treatment for essential tremor?
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Neuravive, the MR-guided focused ultrasound treatment for medication-refractory essential tremor, will soon become a Medicare covered benefit in 38 states.

  • Coverage will go into effect on April 1, 2019 for Alaska, California, Oregon, Washington, Idaho, Nevada, Montana, Wyoming, Utah, Arizona, North Dakota, South Dakota, and Hawaii
  • Coverage went into effect on September 24, 2018 for Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia and West Virginia
  • Coverage went into effect on on October 1, 2018 for Kentucky and Ohio
  • Coverage went into effect on July 1, 2018 for Indiana, Iowa, Kansas, Nebraska, Michigan, and Missouri and on April 1, 2018 for Connecticut, Maine, New Hampshire, Rhode Island, Vermont, New York, Massachusetts, Illinois, Wisconsin and Minnesota.

2. Can I travel to other states to receive the Neuravive treatment if my state is not covered?
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It is our understanding that per Medicare Rules and Regulations, Medicare beneficiaries traveling outside of their home state for treatment at a facility providing MRgFUS would be subject to the Medicare contractor coverage decision based on where the treatment is performed. We recommend confirming with your local Medicare contractor prior to treatment.

Blue Cross Blue Shield: It is our understanding that under the Blue Card Network, patients traveling outside of their home state for treatment at a facility providing MRgFUS would be subject to their home plan coverage decision.  We recommend confirming coverage determination with your health plan prior to treatment.

3. Is Neuravive covered under Medicare Part A, Medicare Part B, or a supplemental Medicare plan?
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The Neuravive treatment, also known as Magnetic Resonance guided Focused Ultrasound (MRgFUS), for treatment of essential tremor is covered under Medicare Part B.

 

4. My healthcare provider would like the five-character CPT code for the Neuravive procedure. What is it?
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The current CPT code for MRgFUS is 0398T; Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed.  We are providing this code for general information purposes only; each provider is responsible for its own coding and billing activities.

5. My state doesn’t yet have Medicare coverage for the Neuravive treatment. Why does coverage vary among the states? Are there any plans to expand coverage to all of the states?
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Coverage is determined by local Medicare Administrative Contractors (MACs).  There are 12 MACs across the country, and each one makes separate local coverage decisions that apply to the states it covers.  INSIGHTEC is currently working with all MACs that have not yet approved coverage to secure coverage for the Neuravive treatment.  This process could take several months.  During the process, there will be opportunity for patients to submit public comments to MACs that are considering whether to cover the treatment.  Please check back at this page often for updates on MAC activities or check with your local MAC for more information.  Information about MACs and the states they cover is available on the Medicare website at https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html.

6. Is this procedure covered by Medi-Cal?
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At this time, Medi-Cal, California’s Medicaid program, does not cover MRgFUS.  We understand that Medi-Calis is currently considering coverage; however this process could take several months for a final determination.  Please contact Medi-Cal directly for coverage information.

7. Do private health insurance plans cover the Neuravive treatment?
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The Blue Cross Blue Shield Association has made another POSITIVE coverage decision for MR-guided focused ultrasound treatment for medication-refractory in the treatment of Essential Tremor.  As of February, 2019, Wellmark Blue Cross Blue Shield has updated their coverage policy to include the Neuravive Treatment as a covered benefit!  Wellmark provides coverage in Iowa and South Dakota.

Coverage is effective for:

BCBS Western NY and Blue Shield Northeastern NY
HCSC Texas, Oklahoma, Illinois, New Mexico and Montana
Blue Shield of California
Premera Blue Cross – WA and AK
Regence BCBS – ID, OR, UT & WA
Blue Cross Idaho
BCBS Kansas City: Kansas & Missouri
Arkansas BCBS
BCBS Louisiana
BCBS Mississippi
BCBS Alabama
Florida Blue
BCBS North Carolina
Independence BCBS (Pennsylvania) includes Independence BCBS Commercial, Independence BCBS Medicare Advantage Plan, and Amerihealth
BCBS New Jersey
BCBS Federal Employee Plan (FEP)
Coverage becomes effective February 1, 2019 for BCBS Massachusetts.

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