Traditional MedicareCoverageMedium impact
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
Medicare/CMS - LCD·Neurology, Neurosurgery, Radiology·Local Coverage Determination
Effective date
Apr 1, 2026
We identified it
Jul 28, 2026
Summary
Wellpoint Federal (MAC Part A and Part B) has established a new Local Coverage Determination (LCD L37421) effective April 1, 2026, for Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) treatment of tremor. This policy defines coverage criteria, medical necessity requirements, and billing guidelines for this specialized neurological procedure. Billing teams must implement coverage validation and prior authorization protocols for MRgFUS tremor cases under this MAC jurisdiction.
Action Required
By March 15, 2026: Billing team must obtain and review the full LCD L37421 policy text from the CMS Medicare Coverage Database (link provided) to identify specific CPT/HCPCS codes, coverage criteria, and prior authorization requirements. Before April 1, 2026: (1) Update billing system with any new or modified codes specific to MRgFUS tremor procedures; (2) Configure prior authorization workflow in billing software if required by this LCD; (3) Update encounter forms and provider education materials to reflect MRgFUS coverage criteria and documentation requirements; (4) Train billing and clinical staff on medical necessity documentation needed for MRgFUS claims. Effective April 1, 2026: All MRgFUS tremor claims submitted to Wellpoint Federal MAC should include required documentation per this LCD. Claims submitted without proper authorization or documentation may be denied.