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, is a Medicare covered benefit in 38 states. Medicare coverage includes:

  • Alabama
  • Alaska
  • Arizona
  • California
  • Connecticut
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Maine
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oregon
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming

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. Please contact Medi-Cal directly for coverage information.

7. Do private health insurance plans cover the Neuravive treatment?
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A total of 22 INDEPENDENT Blue Cross Blue Shield Association plans have adopted the National Medical Policy, positive for MR-guided focused ultrasound treatment for medication-refractory in the treatment of Essential Tremor. The Neuravive focused ultrasound treatment as a covered benefit under the following Blue Cross Blue Shield plans:

  • Arkansas BCBS
  • BCBS Alabama
  • BCBS Federal Employee Plan (FEP)
  • BCBS Kansas City: Kansas & Missouri
  • BCBS Louisiana
  • BCBS Massachusetts
  • BCBS Mississippi
  • BCBS North Carolina
  • BCBS South Carolina
  • BCBS Western NY
  • Blue Cross Idaho
  • Blue Shield of California
  • Blue Shield Northeastern NY
  • Capital Blue – Pennsylvania
  • Florida Blue
  • HCSC Texas, Oklahoma, Illinois, New Mexico and Montana
  • Highmark Blue Cross Blue Shield Delaware
  • Highmark Blue Cross Blue Shield Pennsylvania
  • Highmark Blue Cross Blue Shield West Virginia
  • Horizon BCBS New Jersey
  • Independence BCBS (Pennsylvania) includes Independence BCBS Commercial, Independence BCBS Medicare Advantage Plan, and Amerihealth
  • Premera Blue Cross – WA and AK
  • Regence BCBS – ID, OR, UT & WA
  • Wellmark Blue Cross Blue Shield – Iowa and South Dakota
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