Insurance Coverage

INSIGHTEC receives many questions about whether Medicare and other health insurance plans cover the Neuravive focused ultrasound treatment for essential tremor that has not responded to medication. 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 coverage, we recommend that you contact your insurer.

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1. In which states is there Medicare coverage for the Neuravive treatment for essential tremor?
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Coverage became effective in the following states on April 1, 2018:  Connecticut, Maine, New Hampshire, Rhode Island, Vermont, New York, Massachusetts, Illinois, Wisconsin, and Minnesota.  Coverage became effective in Indiana, Iowa, Kansas, Nebraska, Michigan, and Missouri on July 1, 2018.

2. Can I travel to other states to receive the Neuravive treatment if my state is not covered?
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Our general understanding is that Fee-for-Service (FFS) Medicare beneficiaries (beneficiaries who are enrolled in Original Medicare Part B) may obtain health care services from any Medicare-participating provider regardless of location. Beneficiaries enrolled in other types of Medicare plans (such as Medicare Advantage plans) may be limited as to where they obtain Medicare-covered services.  We recommend that you contact Medicare and the Neuravive provider to discuss specific questions relating to Medicare coverage when considering traveling to undergo the procedure.

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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Private health insurance plans may cover the Neuravive treatment in some cases but generally do not cover the treatment in most cases. However, private insurance coverage varies by insurer and changes over time, so please contact  your insurance plan directly regarding current coverage status. Often times, private health insurance plans allow case by case consideration.  Please consult with your health insurance plan for details on this process.  If you are not covered under your health insurance plan, many treatment centers are accepting patients who pay out of pocket – the costs are set by the individual focused ultrasound centers.  Contact a treatment center for information.  A list of treatment centers is available at https://usa.essential-tremor.com/treatment-centers/?page_name=tab-1.