New York State Medicaid Coverage of MRI Guided High Intensity Focused Ultrasound for Essential Tremor
IMPACTED PLANS: Medicaid, HIV SNP, and HARP
TO: All Providers
Effective January 1, 2026, per New York State (NYS) Medicaid guidelines, MetroPlusHealth will cover Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) when billed with CPT code “61715”. MRgFUS thalamotomy is a noninvasive treatment option for medication refractory Essential Tremor (ET) that affects the ability of a person to perform routine activities.
This ultrasound requires prior authorization by MetroPlusHealth and providers must follow the prior authorization rules, as required. For more information, please refer to our medical policy UM-MP228-MRgFUS:
https://metroplus.org/providers/provider-resources/forms-manuals-policies/medical-policies/
Coverage and reimbursement of MRgFUS is limited to members 22 years of age and older who meet the NYS Medicaid coverage criteria outlined below:
- Presence of Medication refractory ET: defined as refractory to at least two trials of pharmaceutical treatment, including at least one first-line agent (i.e., propranalol or primidone).
- Presence of a moderate to severe postural or intention tremor [defined by a score greater than or equal to two on the clinical rating score for tremors (CRST) or another nationally accepted clinical measure of tremor severity] of the dominant hand.
- Disabling Tremor: defined by a score of greater than or equal to two on any of the eight items in the disability subsection of the CRST or another nationally accepted clinical measure of tremor severity
- The member is not a candidate for deep brain stimulation (e.g., advanced age, anticoagulant therapy, surgical comorbidities, or has failed DBS, but has no retained cranial implants).
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].