Does C1607 require prior authorization?

Yes, C1607 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

`C1607`, Neurostimulator, integrated (implantable), rechargeable with all implantable

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Implantation of a vagus nerve stimulation device is consideredmedically necessaryin an individual with medically and surgically refractory seizures as evidenced by:Failure of more than one trial of single or combination antiepileptic medications, as evidenced by persistent seizures or intolerable side effects of drug therapy; andIndividual has failed or is not a candidate for resective epilepsy surgery.
Failure of more than one trial of single or combination antiepileptic medications, as evidenced by persistent seizures or intolerable side effects of drug therapy; and
Individual has failed or is not a candidate for resective epilepsy surgery.
Electronic analysis of an implanted neurostimulator pulse generator system for vagus nerve stimulation is consideredmedically necessarywhen the implantation occurred because the above criteria were met.
Replacement or revision of an implanted neurostimulator pulse generator system (with or without lead changes) for vagus nerve stimulation is consideredmedically necessarywhen:The implantation occurred because the above criteria were met;andThe current implanted device is no longer functioning appropriately.
The implantation occurred because the above criteria were met;and