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.
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.
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
I nned a replacement sometime on a batter for VNS and was wondering if medicare would cover it.
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
I have a question, as to whether VNS will be covered by medicare.
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).
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!!!
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???
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