Aetna · Clinical coverage policy

Aetna Deep Brain Stimulation coverage criteria

Aetna covers deep brain stimulation as medically necessary for disabling refractory essential tremor or idiopathic Parkinson's tremor, severe levodopa-responsive Parkinson's motor complications (UPDRS motor score >=30 off-medication), intractable primary dystonia in persons age 7+, and refractory partial-onset epilepsy in adults 18+ (failed >=3 antiepileptic drugs and >=6 seizures/month), provided the member lacks disqualifying conditions such as dementia, severe depression, cerebral atrophy, Hoehn and Yahr stage V Parkinson's, or basal ganglia lesions at the target site. DBS for essentially all other indications (e.g., depression, OCD, Tourette's, Huntington's, cluster headache, chronic pain, MS or trauma-related tremor, and many others) is considered experimental and investigational.

Policy CPB 0208 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0208

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0208 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Deep Brain Stimulation (CPT 61850), and what gets it denied?

Path
Aetna covers deep brain stimulation as medically necessary for disabling refractory essential tremor or idiopathic Parkinson's tremor, severe levodopa-responsive Parkinson's motor complications (UPDRS motor score >=30 off-medication), intractable primary dystonia in persons age 7+, and refractory partial-onset epilepsy in adults 18+ (failed >=3 antiepileptic drugs and >=6 seizures/month), provided the member lacks disqualifying conditions such as dementia, severe depression, cerebral atrophy, Hoehn and Yahr stage V Parkinson's, or basal ganglia lesions at the target site. DBS for essentially all other indications (e.g., depression, OCD, Tourette's, Huntington's, cluster headache, chronic pain, MS or trauma-related tremor, and many others) is considered experimental and investigational. Coverage criteria include: Intractable tremor (essential tremor OR Parkinson's disease): Unilateral or bilateral DBS of the ventral intermediate (VIM) thalamic nucleus, globus pallidus, or subthalamic nucleus is medically necessary when ALL of the following are met: (1) member does NOT have dementia, severe depression, cerebral atrophy, or Hoehn and Yahr stage V Parkinson's disease; (2) member does NOT have other independent diagnoses explaining failure to respond to medical treatment; (3) member suffers from disabling upper extremity essential tremor unresponsive to drug therapy OR disabling tremor of idiopathic Parkinson's disease refractory to pharmacotherapy; (4) NO focal lesion of the basal ganglia (space-occupying lesion or lacunae) at the target site; AND (5) sufficient residual motor function in the upper extremity to expect improvement after surgery.; Severe, refractory motor complications of Parkinson's disease: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary when ALL of the following are met: (1) minimal score of 30 points on the motor portion of the Unified Parkinson's Disease Rating Scale (UPDRS) when off medication for approximately 12 hours (scale 0-108; higher = more severe); (2) member does NOT have dementia, severe depression, cerebral atrophy, or advanced (Hoehn and Yahr stage V) Parkinson's disease; (3) member is levodopa-responsive with clearly defined 'on' periods; (4) motor complications that cannot be managed with medication; AND (5) presence of at least 2 major Parkinsonism symptoms (tremor, rigidity, bradykinesia).; Intractable primary dystonia: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary for persons 7 years of age or older with intractable primary dystonia, including (ANY of): generalized and/or segmental dystonia, hemidystonia, OR cervical dystonia.; Partial onset seizures (refractory epilepsy): Bilateral stimulation of the anterior nucleus of the thalamus (e.g., Medtronic DBS System for Epilepsy) is medically necessary for adults aged 18 years or older with partial onset seizures with or without secondary generalization to tonic-clonic activity, when ALL of the following are met: (1) have NOT responded to 3 or more antiepileptic medications; AND (2) have averaged 6 or more seizures per month during the previous 3 months, with no more than 30 days between seizures (not evaluated/established in persons with less frequent seizures).; Preoperative brain MRI: Brain MRI with or without contrast is medically necessary for preoperative planning or intraoperative navigation for DBS implantation.. Applies to 17 codes: 61850, 61860, 61863, 61864, 61867, 61868, 61880, 61885, 61886, 61888, 95836, 95970, 95971, 95976, 95977, 95983, 95984.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Experimental and investigational - tremor due to causes OTHER than essential tremor or idiopathic Parkinson's disease, including tremor from: trauma, multiple sclerosis (MS), degenerative disorders, metabolic disorders, infectious diseases, or drug-induced movement disorders (effectiveness not established).; Experimental and investigational - Alzheimer's disease.; Experimental and investigational - anorexia nervosa.; Experimental and investigational - autism spectrum disorder.; Experimental and investigational - blepharospasm.; Experimental and investigational - chemical dependency / substance use disorders (alcohol, cocaine, nicotine, opioids, psychostimulants).; Experimental and investigational - chronic cluster headache.; Experimental and investigational - depression (despite HDE approval for severe OCD).; Experimental and investigational - obsessive-compulsive disorder (OCD).; Experimental and investigational - Tourette syndrome.; Experimental and investigational - cerebral palsy.; Experimental and investigational - chorea-acanthocytosis.; Experimental and investigational - chronic pain syndrome (including complex regional pain syndrome / reflex sympathetic dystrophy).; Experimental and investigational - chronic vegetative state.; Experimental and investigational - disorders of consciousness (minimally conscious state, unresponsive wakefulness syndrome, vegetative state).; Experimental and investigational - dystonia and spasticity secondary to anoxic brain injury.; Experimental and investigational - explosive aggressive behavior.; Experimental and investigational - head or voice tremor.; Experimental and investigational - Huntington's disease.; Experimental and investigational - movement disorders after stroke.; Experimental and investigational - obesity.; Experimental and investigational - orthostatic tremor.; Experimental and investigational - post-traumatic tremor.; Experimental and investigational - postural trunk deformities.; Experimental and investigational - self-injurious behavior.; Experimental and investigational - status dystonicus.; Experimental and investigational - tinnitus.; Experimental and investigational - traumatic brain injury.; Experimental and investigational - Parkinson's disease symptom: camptocormia.; Experimental and investigational - Parkinson's disease symptom: dysarthria / speech deficits.; Experimental and investigational - Parkinson's disease symptom: postural instability.; Experimental and investigational - Parkinson's disease symptom: restless legs syndrome.; Experimental and investigational - Parkinson's disease symptom: gait disorders (gait instability, freezing of gait).; Not covered - placement of fiducials (e.g., WayPoint anchor) for DBS implantation; described as integral to lead implantation and not reimbursed separately.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has dementia.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has severe depression.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has cerebral atrophy.; Excluded from medically necessary DBS coverage if member has Hoehn and Yahr stage V Parkinson's disease (characterized by cachectic state, inability to stand/walk, invalidism, requiring constant nursing care).; Excluded from medically necessary DBS coverage if member has a focal basal ganglia lesion (space-occupying lesion or lacunae) at the target site.; Excluded from medically necessary DBS coverage if member has insufficient residual upper-extremity motor function to expect improvement after surgery.; Excluded due to other independent diagnoses explaining failure to respond to medical treatment.; Contraindication to DBS: patients requiring electroconvulsive (shock) therapy.; Contraindication to DBS: patients who will undergo MRI or diathermy. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0208 — Deep Brain Stimulation

Coverage criteria

  • Intractable tremor (essential tremor OR Parkinson's disease): Unilateral or bilateral DBS of the ventral intermediate (VIM) thalamic nucleus, globus pallidus, or subthalamic nucleus is medically necessary when ALL of the following are met: (1) member does NOT have dementia, severe depression, cerebral atrophy, or Hoehn and Yahr stage V Parkinson's disease; (2) member does NOT have other independent diagnoses explaining failure to respond to medical treatment; (3) member suffers from disabling upper extremity essential tremor unresponsive to drug therapy OR disabling tremor of idiopathic Parkinson's disease refractory to pharmacotherapy; (4) NO focal lesion of the basal ganglia (space-occupying lesion or lacunae) at the target site; AND (5) sufficient residual motor function in the upper extremity to expect improvement after surgery.
  • Severe, refractory motor complications of Parkinson's disease: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary when ALL of the following are met: (1) minimal score of 30 points on the motor portion of the Unified Parkinson's Disease Rating Scale (UPDRS) when off medication for approximately 12 hours (scale 0-108; higher = more severe); (2) member does NOT have dementia, severe depression, cerebral atrophy, or advanced (Hoehn and Yahr stage V) Parkinson's disease; (3) member is levodopa-responsive with clearly defined 'on' periods; (4) motor complications that cannot be managed with medication; AND (5) presence of at least 2 major Parkinsonism symptoms (tremor, rigidity, bradykinesia).
  • Intractable primary dystonia: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary for persons 7 years of age or older with intractable primary dystonia, including (ANY of): generalized and/or segmental dystonia, hemidystonia, OR cervical dystonia.
  • Partial onset seizures (refractory epilepsy): Bilateral stimulation of the anterior nucleus of the thalamus (e.g., Medtronic DBS System for Epilepsy) is medically necessary for adults aged 18 years or older with partial onset seizures with or without secondary generalization to tonic-clonic activity, when ALL of the following are met: (1) have NOT responded to 3 or more antiepileptic medications; AND (2) have averaged 6 or more seizures per month during the previous 3 months, with no more than 30 days between seizures (not evaluated/established in persons with less frequent seizures).
  • Preoperative brain MRI: Brain MRI with or without contrast is medically necessary for preoperative planning or intraoperative navigation for DBS implantation.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Deep Brain Stimulation (CPT 61850), and what gets it denied?
Aetna covers deep brain stimulation as medically necessary for disabling refractory essential tremor or idiopathic Parkinson's tremor, severe levodopa-responsive Parkinson's motor complications (UPDRS motor score >=30 off-medication), intractable primary dystonia in persons age 7+, and refractory partial-onset epilepsy in adults 18+ (failed >=3 antiepileptic drugs and >=6 seizures/month), provided the member lacks disqualifying conditions such as dementia, severe depression, cerebral atrophy, Hoehn and Yahr stage V Parkinson's, or basal ganglia lesions at the target site. DBS for essentially all other indications (e.g., depression, OCD, Tourette's, Huntington's, cluster headache, chronic pain, MS or trauma-related tremor, and many others) is considered experimental and investigational. Coverage criteria include: Intractable tremor (essential tremor OR Parkinson's disease): Unilateral or bilateral DBS of the ventral intermediate (VIM) thalamic nucleus, globus pallidus, or subthalamic nucleus is medically necessary when ALL of the following are met: (1) member does NOT have dementia, severe depression, cerebral atrophy, or Hoehn and Yahr stage V Parkinson's disease; (2) member does NOT have other independent diagnoses explaining failure to respond to medical treatment; (3) member suffers from disabling upper extremity essential tremor unresponsive to drug therapy OR disabling tremor of idiopathic Parkinson's disease refractory to pharmacotherapy; (4) NO focal lesion of the basal ganglia (space-occupying lesion or lacunae) at the target site; AND (5) sufficient residual motor function in the upper extremity to expect improvement after surgery.; Severe, refractory motor complications of Parkinson's disease: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary when ALL of the following are met: (1) minimal score of 30 points on the motor portion of the Unified Parkinson's Disease Rating Scale (UPDRS) when off medication for approximately 12 hours (scale 0-108; higher = more severe); (2) member does NOT have dementia, severe depression, cerebral atrophy, or advanced (Hoehn and Yahr stage V) Parkinson's disease; (3) member is levodopa-responsive with clearly defined 'on' periods; (4) motor complications that cannot be managed with medication; AND (5) presence of at least 2 major Parkinsonism symptoms (tremor, rigidity, bradykinesia).; Intractable primary dystonia: Unilateral or bilateral DBS of the globus pallidus or subthalamic nucleus is medically necessary for persons 7 years of age or older with intractable primary dystonia, including (ANY of): generalized and/or segmental dystonia, hemidystonia, OR cervical dystonia.; Partial onset seizures (refractory epilepsy): Bilateral stimulation of the anterior nucleus of the thalamus (e.g., Medtronic DBS System for Epilepsy) is medically necessary for adults aged 18 years or older with partial onset seizures with or without secondary generalization to tonic-clonic activity, when ALL of the following are met: (1) have NOT responded to 3 or more antiepileptic medications; AND (2) have averaged 6 or more seizures per month during the previous 3 months, with no more than 30 days between seizures (not evaluated/established in persons with less frequent seizures).; Preoperative brain MRI: Brain MRI with or without contrast is medically necessary for preoperative planning or intraoperative navigation for DBS implantation.. Applies to 17 codes: 61850, 61860, 61863, 61864, 61867, 61868, 61880, 61885, 61886, 61888, 95836, 95970, 95971, 95976, 95977, 95983, 95984. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental and investigational - tremor due to causes OTHER than essential tremor or idiopathic Parkinson's disease, including tremor from: trauma, multiple sclerosis (MS), degenerative disorders, metabolic disorders, infectious diseases, or drug-induced movement disorders (effectiveness not established).; Experimental and investigational - Alzheimer's disease.; Experimental and investigational - anorexia nervosa.; Experimental and investigational - autism spectrum disorder.; Experimental and investigational - blepharospasm.; Experimental and investigational - chemical dependency / substance use disorders (alcohol, cocaine, nicotine, opioids, psychostimulants).; Experimental and investigational - chronic cluster headache.; Experimental and investigational - depression (despite HDE approval for severe OCD).; Experimental and investigational - obsessive-compulsive disorder (OCD).; Experimental and investigational - Tourette syndrome.; Experimental and investigational - cerebral palsy.; Experimental and investigational - chorea-acanthocytosis.; Experimental and investigational - chronic pain syndrome (including complex regional pain syndrome / reflex sympathetic dystrophy).; Experimental and investigational - chronic vegetative state.; Experimental and investigational - disorders of consciousness (minimally conscious state, unresponsive wakefulness syndrome, vegetative state).; Experimental and investigational - dystonia and spasticity secondary to anoxic brain injury.; Experimental and investigational - explosive aggressive behavior.; Experimental and investigational - head or voice tremor.; Experimental and investigational - Huntington's disease.; Experimental and investigational - movement disorders after stroke.; Experimental and investigational - obesity.; Experimental and investigational - orthostatic tremor.; Experimental and investigational - post-traumatic tremor.; Experimental and investigational - postural trunk deformities.; Experimental and investigational - self-injurious behavior.; Experimental and investigational - status dystonicus.; Experimental and investigational - tinnitus.; Experimental and investigational - traumatic brain injury.; Experimental and investigational - Parkinson's disease symptom: camptocormia.; Experimental and investigational - Parkinson's disease symptom: dysarthria / speech deficits.; Experimental and investigational - Parkinson's disease symptom: postural instability.; Experimental and investigational - Parkinson's disease symptom: restless legs syndrome.; Experimental and investigational - Parkinson's disease symptom: gait disorders (gait instability, freezing of gait).; Not covered - placement of fiducials (e.g., WayPoint anchor) for DBS implantation; described as integral to lead implantation and not reimbursed separately.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has dementia.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has severe depression.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has cerebral atrophy.; Excluded from medically necessary DBS coverage if member has Hoehn and Yahr stage V Parkinson's disease (characterized by cachectic state, inability to stand/walk, invalidism, requiring constant nursing care).; Excluded from medically necessary DBS coverage if member has a focal basal ganglia lesion (space-occupying lesion or lacunae) at the target site.; Excluded from medically necessary DBS coverage if member has insufficient residual upper-extremity motor function to expect improvement after surgery.; Excluded due to other independent diagnoses explaining failure to respond to medical treatment.; Contraindication to DBS: patients requiring electroconvulsive (shock) therapy.; Contraindication to DBS: patients who will undergo MRI or diathermy. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Deep Brain Stimulation?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Deep Brain Stimulation?
Policy exclusions and limitations: Experimental and investigational - tremor due to causes OTHER than essential tremor or idiopathic Parkinson's disease, including tremor from: trauma, multiple sclerosis (MS), degenerative disorders, metabolic disorders, infectious diseases, or drug-induced movement disorders (effectiveness not established).; Experimental and investigational - Alzheimer's disease.; Experimental and investigational - anorexia nervosa.; Experimental and investigational - autism spectrum disorder.; Experimental and investigational - blepharospasm.; Experimental and investigational - chemical dependency / substance use disorders (alcohol, cocaine, nicotine, opioids, psychostimulants).; Experimental and investigational - chronic cluster headache.; Experimental and investigational - depression (despite HDE approval for severe OCD).; Experimental and investigational - obsessive-compulsive disorder (OCD).; Experimental and investigational - Tourette syndrome.; Experimental and investigational - cerebral palsy.; Experimental and investigational - chorea-acanthocytosis.; Experimental and investigational - chronic pain syndrome (including complex regional pain syndrome / reflex sympathetic dystrophy).; Experimental and investigational - chronic vegetative state.; Experimental and investigational - disorders of consciousness (minimally conscious state, unresponsive wakefulness syndrome, vegetative state).; Experimental and investigational - dystonia and spasticity secondary to anoxic brain injury.; Experimental and investigational - explosive aggressive behavior.; Experimental and investigational - head or voice tremor.; Experimental and investigational - Huntington's disease.; Experimental and investigational - movement disorders after stroke.; Experimental and investigational - obesity.; Experimental and investigational - orthostatic tremor.; Experimental and investigational - post-traumatic tremor.; Experimental and investigational - postural trunk deformities.; Experimental and investigational - self-injurious behavior.; Experimental and investigational - status dystonicus.; Experimental and investigational - tinnitus.; Experimental and investigational - traumatic brain injury.; Experimental and investigational - Parkinson's disease symptom: camptocormia.; Experimental and investigational - Parkinson's disease symptom: dysarthria / speech deficits.; Experimental and investigational - Parkinson's disease symptom: postural instability.; Experimental and investigational - Parkinson's disease symptom: restless legs syndrome.; Experimental and investigational - Parkinson's disease symptom: gait disorders (gait instability, freezing of gait).; Not covered - placement of fiducials (e.g., WayPoint anchor) for DBS implantation; described as integral to lead implantation and not reimbursed separately.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has dementia.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has severe depression.; Excluded from medically necessary DBS coverage (tremor and Parkinson's indications) if member has cerebral atrophy.; Excluded from medically necessary DBS coverage if member has Hoehn and Yahr stage V Parkinson's disease (characterized by cachectic state, inability to stand/walk, invalidism, requiring constant nursing care).; Excluded from medically necessary DBS coverage if member has a focal basal ganglia lesion (space-occupying lesion or lacunae) at the target site.; Excluded from medically necessary DBS coverage if member has insufficient residual upper-extremity motor function to expect improvement after surgery.; Excluded due to other independent diagnoses explaining failure to respond to medical treatment.; Contraindication to DBS: patients requiring electroconvulsive (shock) therapy.; Contraindication to DBS: patients who will undergo MRI or diathermy. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0208 — Deep Brain Stimulation

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0208 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.