​​Upcoming changes to billing requirements for deep brain stimulation​

October 26, 2020

Effective January 25, 2021, claims submitted for deep brain stimulation (DBS) with any of the following CPT® codes must include a primary ICD-10 diagnosis code that represents the member's diagnosis:​​​​​

  • 61850
  • 61860
  • 61863
  • 61864
  • 61867
  • 61868
  • 61886 ​​

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.

Updated policies

For more information, including a complete list of medical necessity criteria for DBS and the updated billing requirements, please review the following Independence policies, which were posted as Notifications on October 26, 2020, and will go into effect January 25, 2021:

  • Commercial: #11.15.20p: Deep Brain Stimulation (DBS)
  • Medicare Advantage: #MA11.005d: Deep Brain Stimulation (DBS)

To view these policy Notifications, visit the Active Notifications section of our Medical and Claim Payme​​nt Policy Portal

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.