Since it was approved by the US Food and Drug Administration in July 2016, focused ultrasound treatment for essential tremor has gained incremental reimbursement coverage by the Centers for Medicare and Medicaid Services (CMS). However, the CMS could soon cover all Medicare patients seeking the treatment in the US.
Medicare coverage is divided into 12 regional Medicare Administrative Contractors (MACs) that are tasked with administering local Medicare plans. Most MACs have already agreed to pay for focused ultrasound treatment of essential tremor in many states, but three of them – covering FL, AR, CO, DE, LA, MD, MS, NJ, NM, OK, PA, TX, and Washington, DC – held out on positive coverage determinations. This changed on December 26, 2019, when these three announced preliminary plans to reimburse focused ultrasound-based treatment of essential tremor.
However, the coverage determination will not be final until it undergoes a mandatory public comment period and then a 45-day ‘posting period.’
Despite these final hurdles, there is a good chance that all treatment sites in the US will be eligible for Medicare reimbursement by the spring of 2020.
If finalized, this ruling will give eligible patients more choices for treatment centers and could reduce wait times at some sites by more evenly spreading out the patient load. It could also reduce travel time and costs for many patients.
It’s important to keep in mind that not all treatment centers accept Medicare patients, so patients should confirm this beforehand.