Medicare Coverage of Vagus Nerve Stimulation (VNS)


What It Is

Vagus nerve stimulation (VNS) therapy, used in treatment of epilepsy and depression

What's Covered

Whether Medicare Part B covers vagus nerve stimulation (VNS) therapy depends on the medical condition it's prescribed for and the medical history of the patient:

  • Epilepsy. Medicare Part B often covers physician-prescribed VNS therapy for patients with treatment-resistant epilepsy. Treatment-resistant means that standard drug treatments have been tried but weren't successful.

  • Depression. Medicare Part B usually does not cover the use of VNS therapy for treatment of depression. However, if chronic or recurring depression is treatment resistant, meaning that other standard drug and other therapeutic treatments for a patient have failed, a psychiatrist may petition Medicare Part B in advance, on behalf of that particular patient, for coverage of VNS therapy.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans must cover everything that's included in original Medicare Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. To find out whether your plan provides extra coverage for VNS therapy, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for covered VNS therapy.

Co-payments under a Medicare Part C plan may be different than those for Medicare Part B. To find out what the co-payments are under your Medicare Part C plan for VNS therapy, contact the plan directly.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

10 Comments So Far. Add Your Wisdom.

about 1 month ago

I need help! In 2006 I was implanted with a VNS. My medical hx which allowed this treatment is as follows
 1. suffered from TRD for over 20 (verified by my Psychiatrist)
 2. treatment has included (unsuccessfully) every type of antidepressant approved by FDA (including an MAOI which sent me into cardiac arrest)
 3. over 50 ECT sessions which caused a major memory loss and worsening my depression
 4. I see a psychotherapist at least 2x a month
 5. I have seen 3 top psychiatrist for evaluation and treatment options...same diagnosis options tried and did not help
 
 In July 2012 my depression started to worsen after 6 years of much improvement with VNS THERAPY. My Drs. were at a loss to find what triggered my relapse. The batteries for my VNS had been checked and were working in May 2012 so that was ruled out as a cause. In Jan 2013 the batteries were rechecked and were found to be nonfunctioning. Relieved to have isolated this cause, my psychiatrist sent Medicare the preapproval forms and I saw a neurosurgeon who would be replacing my batteries.
 Much to everyone's surprise, Medicare denied the request. 
 I then learned that after the FDA approved VNS for TRD in 2005, Medicare issued a National Coverage Determination Letter in 2007 stating that VNS Therapy for Treatment Depression would NOT be covered by Medicare because it was deemed to be still investigational! to make this even worse the NCD went on to say that patients already implanted with a VNS would no longer be covered without regard to the benefit the patient received with the VNS.
 
 I started my appeals process in Feb 2013 and was denied at each level because Medicare felt no long term study showed there was enough efficacy w/r/t to TRD.
 I finally requested an Administrative Law Judge Hearing. When I received confirmation of the hearing I discovered it was with a Judge in Irvine, Ca. I live in Buffalo, NY! At my own expense (Medicare only covers mileage traveled by car!) I flew to Ca., spent 2 days in a hotel, and presented my case to the Judge. A month later I found my appeal denied again because I could not present an acceptable LT study. 
 I was told that if I could produce a LT study, my appeal would be reviewed by another Medicare Panel. I found a recently Published Meta-Analytical Study Published by Dover Press and written by DRS. from prominent Colleges and Hospitals. My Drs. reviewed the study and felt it sufficiently proved that VNS Therapy benefitted a majority of TRD patients.
 I forwarded the study along with letters from myself and my Drs. in Nov. 2013. I didn't get a response that my appeal was received (I faxed the info and had the receipt showing my fax was received the day it was sent), so in Feb 2014 I called the number listed on the appeal request. I was told they were "overloaded" and had a long backlist. I requested that at least I wanted confirmation that my appeal had been received. Then I found out it had been received in Nov. but had not been opened yet.
 
 Currently I spend most of my time isolated in my bedroom. I have very little that evens interests me. I suffer from panic attacks that I can't even go shopping or get my hair cut. A year and a half ago I had a life. I don't know what will happen to me if my appeal is denied again.
 
 I must also include the fact that Medicare has covered VNS therapy for certain types of Epilepsy since 1997. I guess you can quantify seizures better that a psychiatrist can testify to the improvement in the most difficult to treat patients. I don't see this as medical parity which is the foundation of Pres. Obama's Mental Health Parity Law which became effective Jan 2014!
 
 If anyone has been in my situation or has any advice please help me


about 2 years ago

Hi! I am hoping you can help me. My diagnosis is Bipolar I - Mixed States - Ultra - Rapid Cycler. I was diagnosed 15yrs ago, and have been on disability for 10yrs. I have seen numerous Psychiatrists. I started maintenence ECT treatment a year ago, and have continued my meds (Lithium, Tegretol and Lamictal). I started with going every 2 weeks, then every 3 now at every 4 weeks. Problem is, I cant really go beyond 2 weeks without becoming sympomatic! I have done some research, and am very interested in VNS. My question is, based upon my bio, would I be a candidate? Thank you for your time, and I look forward to your reply.


almost 3 years ago

Hi sticklesanne­, Thanks for your question. If you'd like, you can post a question in our Ask & Answer section, located here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


almost 3 years ago

I nned a replacement sometime on a batter for VNS and was wondering if medicare would cover it.


almost 3 years ago

Hi sticklesanne­, Thanks for your question! Here is a page about if VSN and Medicare coverage that you may find helpful, ( http://www.caring.com/medicare_information/medicare-coverage-of-vagus-nerve-stimulation ). I hope that helps. Take care -- Emily | Community Manager


almost 3 years ago

I have a question, as to whether VNS will be covered by medicare.


about 3 years ago

Hi tina411tina, Thanks for your questions. I personally don't know the answers to your questions, but you can post your questions in our Ask & Answer section here: (http://www.caring.com/questions/new).


about 3 years ago

depression too! this site states if its for treatment resistant depression with a doctors note medicare part b covers 80% of it. who discovered this?? Who posted that?? I want to know because this is huge if thats the case, so many people out there with medicare and treatment resistant depression can have VNS and responde!!!


about 3 years ago

this is so helpful, how true is this? I went to a neurologist and he said medicare doesnt cover treatement resistant depression. My husband who has a severve case of, where are your sources???


over 3 years ago

Patients with partial seizures in their case, Vagus Nerve Stimulation can be used. Also who have not responded well to anti epileptic medicines, and who are not candidates for epilepsy surgery. http://www.whatisguide.net/0103-vagus-nerve-stimulation.html


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