Aetna's Vagus Nerve Stimulation policy (CPB 0191, reviewed March 31, 2026) considers vagus nerve electrical stimulators medically necessary durable medical equipment for focal seizures or Lennox-Gastaut syndrome in members who remain refractory to optimal anti-epileptic medications and/or surgical intervention, or who have debilitating side effects from anti-epileptic medications, and who have no history of a bilateral or left cervical vagotomy. Replacement or revision of a system is considered medically necessary when the original system met criteria, is no longer under warranty, and cannot be repaired. Integrated VNS for multiple sclerosis, psoriatic arthritis and rheumatoid arthritis, transcutaneous VNS for seizures and post-laminectomy syndrome, VNS for prevention of chronic migraine, and VNS for all other listed indications (such as depression, obesity and tinnitus) are considered experimental, investigational or unproven.
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01Billing team: For focal seizures or Lennox-Gastaut syndrome, document that the member remains refractory to optimal anti-epileptic medications and/or surgical intervention, or has debilitating side effects from anti-epileptic medications, and has no history of a bilateral or left cervical vagotomy.
02Bill electronic analysis of an implanted vagus nerve pulse generator system (CPT 95970 or 95976) when those criteria are met.
03Replacement or revision of a vagus nerve system (CPT 64569) is considered medically necessary when the original system met criteria, is no longer under warranty and cannot be repaired.
04Billing team: Do not submit charges for the transcutaneous or integrated VNS codes that the policy lists as not covered for its listed indications, including CPT 0908T through 0912T.
05Billing team: Use the covered ICD-10 codes G40.001 through G40.019, G40.101 through G40.219 and G40.811 through G40.814 on VNS claims for these seizure types.
Summaries are AI-assisted. Always confirm against the original payer notice.
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