Insurance Reimbursement for Vagus Nerve Stimulation and Depression

I attended the Vagus Nerve Stimulation Therapy Conference at the manufacturers' (Cyberonics) headquarters in Houston, TX in late July. The Conference presenters included senior management, psychiatric thought leaders and study investigators from the investigational clinical trial. In this article , I will limit the discussion to the question that I am asked most often; will insurance companies or Medicare cover vagus nerve stimulation for Depression?

Third Party Reimbursement

I had received several e-mails from patients, who had the implant prior to final FDA approval and their insurance covered all or most of the procedure. These were isolated cases, but I think it is worth noting. The presenter for this portion of the Conference was Shawn Lunney, Vice President, Market Development and Engineering.

Will third party payers reimburse VNS Therapy for Depression? Shawn's answer was yes, but it will take some time and vary policy by policy. Three main issues:

Coverage

Coding

Reimbursement

In my book, Out of the Black: The Patient's Guide to Vagus Nerve Stimulation and Depression, I list all of the coverage codes as well as guidance (with help from The Patient Advocate Foundation) as to the reimbursement process. The reimbursement fundamentals for VNS Therapy related procedures are very solid. "Coverage in epilepsy is virtually universal; coding is clear, adequately describes the procedures performed and provides reasonable payment for services rendered by all providers"-Cyberonics

Shawn made a very interesting statement: "Medicare is the great equalizer". Medicare fully covers VNS Therapy for epilepsy and reimburses approximately $24,500. The procedure is identical for epilepsy as it is for Depression. I got the impression that publication of the study results in peer reviewed Journals is critical. The studies have already been accepted in prestigious journals such as Biological Psychiatry and Journal of Clinical Psychiatry.

Psychiatrists are just beginning to receive the VNS Depression Kit. The Kit will include an overview of vagus nerve stimulation and reimbursement support materials. I think that initially approval will be on a case-by-case basis and gradually expand to the overall policy level. If your psychiatrist prescribes VNS for your condition, you will be assigned a case manager. The case manager will help you with further patient education as well as referrals to surgeons trained in the implant procedure.

Enter discount code FDAYES (all caps) and save 25% off the cover price of the book and get free shipping via U.S. Postal Priority Mail. The discount code applies only to orders placed on this site or through the 24 hour/7 days a week 1-888-VAGUS-88 toll-free number.

You can purchase the book on this Web Site, at 1-888-VAGUS-88, or you can purchase the book directly from Amazon.com or Barnes & Noble.com.

You will need a prescription from your psychiatrist for vagus nerve stimulation therapy. A surgeon will implant the pacemaker-like device in your upper left chest. There is much for you to learn about this treatment option. Do yourself a favor and try to start now. You have suffered long enough. I wanted the implant as soon as possible. And I was fortunate enough to get the implant four and a half years ago.

176 Pages, 14 chapters, 9 illustrations, 11 appendices

Easy-to Understand explanations about this 90-minute out-patient procedure

What is vagus nerve stimulation and how does it work?

Insurance reimbursement process, including codes and sample letters to obtain insurance approval

The side effects and benefits of the VNS

How to locate a psychiatrist or surgeon in your geographical area familiar with vagus nerve stimulation

The latest research about the biological disease of Depression from the American Psychiatric Association

I will publish another article