Ultrasonic Surgery Form
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Background for this Policy
Reimbursement may be made for ultrasonic surgery when required in the treatment of patients with severe and recurrent episodes of vertigo due to Meniere's syndrome. This procedure utilizes a machine that produces ultrasonic waves of high intensity and frequency that selectively irradiate certain portions of the inner ear thereby destroying the tissue. The procedure is usually done under local anesthesia, and requires the services of a surgeon and another individual who is responsible for calibrating the electrical equipment, and who assists in observing certain physical changes (e.g., movement of the eyes, "nystagmus") indicative of inner ear reaction to the ultrasonic destruction. Except in rare instances the desired result is achieved with one treatment. At present, there are two different approaches being used to apply the ultrasound to the inner ear: one through the lateral semicircular canal and, more recently, a simpler approach from a technical viewpoint, through the round window.
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Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.