CommercialCoverageMedium impact
Deep Brain Stimulation 7.01.23
Excellus BlueCross BlueShield·Neurology, Neurosurgery·Nervous Systems (Neurology)
Effective date
Apr 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their Deep Brain Stimulation policy effective April 16, 2026, establishing specific medical necessity criteria for DBS procedures including VIM thalamus stimulation for tremors, STN/GPi stimulation for Parkinson's disease, dystonia treatment, and anterior nucleus stimulation for refractory epilepsy. The policy also specifies contraindications and covers device repair/replacement guidelines.
Action Required
Before April 16, 2026: Billing and clinical teams must review and implement updated medical necessity criteria for Deep Brain Stimulation procedures. Ensure documentation includes specific requirements such as UPDRS scores ≥30 for Parkinson's patients, 3+ month medication trials for tremor patients, and contraindication screening. Update prior authorization workflows to verify patients meet age requirements (7+ for dystonia, 18+ for epilepsy) and seizure frequency criteria. Claims may be denied if medical necessity criteria are not met and documented.