Vagus nerve stimulation in the treatment of epilepsy: Payment policy perspectives.

This article is presented as a companion to the recent American Academy of Neurology (AAN) guideline update on use of vagus nerve stimulation (VNS) for treating epilepsy. The guideline update reaffirms the efficacy of VNS for intractable epilepsy. Whereas it upholds the value of VNS for its originally approved indications, the guideline reminds us of existing evidence gaps and unmet research needs. This companion identifies ambiguities in the definition of intractable epilepsies and discusses the use of VNS in children under age 12 years and in persons with intellectual disabilities (mental retardation). Many payers require prior authorization and fulfillment of criteria for coverage of VNS. This article provides guidance and background information to reduce obstacles for coverage, especially where uncertainties exist and levels of evidence are lower.