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Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Responsive neurostimulation may be considered medically necessary for individuals with focal epilepsy who are 18 years or older, have focal seizures with 1 or 2 well-localized seizure foci, average 3 or more disabling seizures per month over the prior 3 months, have failed 2 or more appropriate antiepileptic medications at therapeutic doses, are not candidates for focal resective epilepsy surgery, and have no contraindications to device placement. Responsive neurostimulation is considered investigational for all other indications. The policy was last reviewed on 06/06/2025 with no changes.
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What to do
Action · 3 steps
01Confirm the individual meets all of the policy criteria before billing responsive neurostimulation: age 18 or older; a diagnosis of focal seizures with 1 or 2 well-localized seizure foci; an average of 3 or more disabling seizures per month over the prior 3 months (such as motor focal seizures, complex focal seizures, or secondary generalized seizures); failure of 2 or more appropriate antiepileptic medications at therapeutic doses; not a candidate for focal resective epilepsy surgery (for example, an epileptic focus near eloquent cerebral cortex or bilateral temporal epilepsy); and no contraindications to device placement.
02Contraindications include 3 or more specific seizure foci, primary generalized epilepsy, or a rapidly progressive neurologic disorder.
03The codes listed are only medically necessary if the procedure is performed according to the policy section of the document.
Codes mentioned
618506186061863618646188061885618866188861889618916189295970959719598395984L8680L8686L8688G40.201G40.209G40.211G40.219G40.001G40.009G40.101G40.109G40.011G40.019G40.111G40.119
Original notice
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
bcbsms.com · Always check the source before changing claims.
Related changes
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Related policy hubs
Blue Cross & Blue Shield of Mississippi policiesNeurologyNeurosurgeryCode 61850Code 61860Code 61863Code 61864Code 61880Code 61885Code 61886Code 61888Code 61889Code 61891Code 61892Code 95970Code 95971Code 95983Code 95984Code L8680Code L8686Code L8688Code G40.201Code G40.209Code G40.211Code G40.219Code G40.001Code G40.009Code G40.101Code G40.109Code G40.011Code G40.019Code G40.111Code G40.119