Effective January 25, 2021,
claims submitted for deep brain stimulation (DBS) with any of the following CPT®
include a primary ICD-10 diagnosis code that represents the member's diagnosis:
In accordance with our policy on DBS, this service is considered Medically Necessary for essential tremor, Parkinson's disease, dystonia, torticollis, or obsessive-compulsive disorder. Claims submitted
without an appropriate diagnosis code will
not be covered.
For more information, including a complete list of medical necessity criteria for DBS and the updated billing requirements, please review AmeriHealth Medical Policy #11.15.20p: Deep Brain Stimulation (DBS), which was posted as a Notification on October 26, 2020, and will go into effect
January 25, 2021.
To view the policy Notification, visit the Active Notifications section of our
Medical and Claim Payment Policy Portal.
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