Insurance Coverage

INSIGHTEC receives many questions about whether Medicare and other health insurance plans cover the Neuravive treatment for essential tremor. We answer some frequently asked questions below. Please check this page often for updates, as coverage information is subject to change. In addition, to obtain the most current and accurate information about your plan and how it applies to you, please contact your insurer.

1. In which states is there Medicare coverage for the Neuravive treatment for essential tremor?
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Neuravive, is now a Medicare covered benefit in 25 states:

Alabama, Georgia, North Carolina, South Carolina, Tennessee, Virginia, West Virginia, Kentucky, Ohio, Indiana, Iowa, Kansas, Nebraska, Michigan, Missouri, 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.

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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Blue Cross Blue Shield Association has made a POSITIVE coverage decision related to MR-guided focused ultrasound treatment for medication-refractory in the treatment of Essential Tremor!   Some BCBS plans have already adopted the policy, and it is anticipated that over the next 6 to 12 months additional Blue Cross Blue Shield (BCBS) plans will begin adopting the policy.  The following BCBS plans cover, or will soon cover, Neuravive, the MR-guided focused ultrasound treatment for medication-refractory essential tremor:

Coverage is now effective for:

  • Arkansas BCBS
  • BCBS Alabama
  • Regence BCBS – ID, OR, UT & WA
  • BCBS North Carolina
  • BCBS New Jersey
  • Florida Blue
  • Premera Blue Cross – WA and AK

Coverage becomes effective October 30, 2018 for Blue Cross Idaho

Coverage becomes effective December 1, 2018 for BCBS Massachusetts

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