Medicare Coverage of Vagus Nerve Stimulation (VNS)
What It Is
Vagus nerve stimulation (VNS) therapy, used in treatment of epilepsy and depression
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.