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VNS Therapy Patient Eligibility, Education and Authorization Form

VNS Therapy Patient Eligibility, Education and Authorization Form 2025

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The document is a VNS Therapy Patient Eligibility, Education and Authorization Form used by physicians to request authorization for vagus nerve stimulation implants for patients with specific types of intractable epilepsy. It includes sections for physician and patient information, diagnosis codes, insurance details, and consent for the release of protected health information to LivaNova for insurance verification and ongoing support related to VNS Therapy.

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What is the indication of vagus nerve stimulation?

It is indicated as an adjunctive treatment of epilepsy that is refractory to antiepileptic medications and for treatment-resistant depression.

How do you qualify for VNS?

When Is Vagus Nerve Stimulation Used? VNS is used for people with refractory or drug-resistant epilepsy. This means seizures are not controlled after trying at least 2 appropriate seizure medications. Its an add-on treatment, which means it is used in addition to seizure medicines.

Who should not get a VNS?

The safety and efficacy of VNS Therapy have not been shown for people with these conditions: history of previous therapeutic brain surgery or brain injury, dysautonomias, lung diseases or disorders, including shortness of breath and asthma, ulcers (gastric, duodenal, or other), fainting (vasovagal syncope); irregular

Who is a candidate for VNS?

Who is a Candidate? Patients who suffer from partial seizures, and dont have other serious medical conditions, are considered good candidates for VNS. About 80 percent of all epilepsy patients get the relief they need from medication.

What precautions should be taken during vagal nerve stimulator?

Precautions with vagus nerve stimulation Physical trauma to the pulse generator or lead wire, such as with rough sport or neck manipulation, can damage the device. Equipment that may interfere with the stimulator should be avoided. These include strong magnets, hair clippers and loudspeakers.

How do they test for vagus nerve damage?

How are vagus nerve disorders diagnosed? Your healthcare provider may order one of these tests to diagnose a problem with your vagal nerves: CT scan or MRI to look for intestinal blockages. Echocardiogram to assess heart function.

Does insurance cover vagus nerve stimulation?

VNS is non-covered for the treatment of TRD when furnished outside of a CMS-approved CED study. All other indications of VNS for the treatment of depression are nationally non-covered.

VNS Therapy Patient Eligibility, Education and Authorization Form 2025

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