Neurology reimbursement alerts

Imaavy (nipocalimab-aahu), a new molecular entity approved by FDA on April 29, 2025, is an injectable drug administered via injection, placing it on a Part B billing pathway where it will likely be re

This approval is a new oral formulation of duloxetine (delayed-release pellet capsule) by Almatica Pharma LLC, following a Type 5 NDA pathway, and will be covered under Medicare Part D as a self-admin

Zavzpret (zavegepant) was approved by the FDA on March 9, 2023, as a nasal spray for migraine treatment, billing under Medicare Part D as a self-administered drug. As a nasal spray administered outsid

Orzeyful (oveporexton), approved by FDA on August 5, 2026, is an oral tablet indicated for a condition treated under Part D coverage, placing it in the retail pharmacy benefit rather than the medical

MEZOFY (aripiprazole) is an oral film formulation approved under NDA211448, representing a new dosage form of an established antipsychotic agent. As an oral drug, it follows the Part D billing pathway

This retired final LCD from Palmetto GBA governs coverage of MRgFUS for essential tremor across seven southeastern states under Part A and B. The policy was effective June 2024 and retired as of July

Neuraceq (florbetaben F 18) is an intravenous radioactive diagnostic agent approved for PET imaging of amyloid plaques in the brain, administered in a clinical setting. As an intravenous radiopharmace

TYRUKO (natalizumab-sztn) is a biosimilar to Tysabri (natalizumab), approved as an injectable administered via intravenous infusion, placing it firmly in the Medicare Part B billing pathway under ASP+

Simtriyo (centanafadine), approved by FDA on July 24, 2026 as a new molecular entity under NDA218145, has an undetermined Medicare billing pathway at this time. Although the dosage form is described a

This active final LCD from Wellpoint Federal governs coverage criteria for autonomic function testing under both Part A and Part B, effective April 1, 2026. It establishes specific indications and doc

This final LCD from Wellpoint Federal establishes coverage criteria for hypoglossal nerve stimulation (HNS) as a treatment for obstructive sleep apnea, effective April 1, 2026. It applies to both Part

Subvenite (lamotrigine) is an oral suspension formulation of the established anti-epileptic lamotrigine, approved under NDA218879 as a new dosage form. As an oral drug, it follows a Part D billing pat

This active final LCD (L33399) from Wellpoint Federal governs coverage of ambulatory EEG monitoring under Medicare Parts A and B, effective April 1, 2026. It establishes the clinical indications, docu

This active final LCD from Wellpoint Federal governs coverage criteria for Nerve Conduction Studies (NCS) and Electromyography (EMG) under Medicare Part A and Part B, effective April 1, 2026. It estab

This active final LCD from Wellpoint Federal establishes coverage criteria for venous angioplasty with or without stent placement for Chronic Cerebrospinal Venous Insufficiency (CCSVI), effective Apri

Tegretol (carbamazepine) oral suspension is an established oral mood stabilizer/anticonvulsant billed under Medicare Part D as a self-administered drug. As a long-standing generic oral medication with

Tegretol XR (carbamazepine) is an oral extended-release tablet approved under NDA020234, routing it to Medicare Part D for outpatient prescription drug coverage. As a long-established oral mood stabil

Tegretol (carbamazepine) is an oral tablet approved under NDA016608, placing it squarely in the Medicare Part D billing pathway as a self-administered medication. As a long-established generic drug wi

Xelstrym (dextroamphetamine) is a transdermal patch approved as a new dosage form of a central nervous system stimulant, indicated for ADHD management. As a transdermal system, it follows a Part D bil

INBRIJA (levodopa) is an inhaled powder formulation approved for intermittent treatment of OFF episodes in Parkinson's disease patients on carbidopa/levodopa. Given its inhalation route of administrat

Tascenso ODT (fingolimod lauryl sulfate) is an orally disintegrating tablet approved for oral administration, placing it squarely in the Medicare Part D billing pathway as a self-administered drug. As

Strattera (atomoxetine HCl) is an oral capsule approved for ADHD, placing it squarely in the Medicare Part D billing pathway as a self-administered medication. As an oral drug, it does not qualify for

Bromocriptine mesylate is an oral tablet approved under NDA017962, which routes to Medicare Part D coverage for eligible beneficiaries. As a long-established oral generic drug with multiple therapeuti

Mayzent (siponimod) is an oral tablet approved for secondary progressive multiple sclerosis, billing under Medicare Part D as a self-administered drug. As an oral specialty medication, it will be disp

ONAPGO (apomorphine hydrochloride) was approved as a subcutaneous solution for what is likely a movement disorder indication, and given its subcutaneous route and Part B billing pathway, it will gener

Xeomin (incobotulinumtoxinA) is an injectable botulinum toxin type A administered via injection, placing it squarely in the Medicare Part B pathway for physician-administered drugs. It is reimbursed u

Enspryng (Satralizumab) is an injectable drug approved for Part B billing, likely leading to a new J-code assignment. With its status as an orphan drug, it may qualify for pass-through payment under M

Emgality (galcanezumab) is likely to receive a new J-code for billing under Medicare Part B since it is an injectable drug. The drug may be eligible for ASP+6% reimbursement, given its injectable stat

VYEPTI (Eptinezumab-JJMR) is an injectable medication likely to receive a J-code for billing under Medicare Part B. Its category may allow for ASP+6% reimbursement, but billing teams should confirm th

Epidiolex, an oral cannabidiol solution, will fall under Medicare Part D for billing purposes. As it is an orphan drug, it may also have specific considerations for reimbursement and coverage. No J-co

Ajovy (fremanezumab-vfrm), an injectable drug approved by the FDA, is expected to receive a J-code assignment for Medicare billing. It is likely to be reimbursed under Part B, potentially utilizing an

The proposed LCD for automated MRI detection and quantification could streamline billing for neurology services, potentially improving efficiency and accuracy in claims processing. This could lead to

The proposed LCD for MRgFUS for tremor could significantly impact billing by introducing clear guidelines for coverage and reimbursement rates. This advancement may encourage more providers to offer t

The proposed LCD DL33398 for Transcranial Magnetic Stimulation is currently open for comments until the deadline. Providers are encouraged to review the draft to assess its potential billing impacts.

The implementation of the LCD for molecular testing in hereditary transthyretin amyloidosis requires billing team review. Providers should be aware of the guide

This final LCD from NGS (J6, JK) establishes coverage criteria for Transcranial Magnetic Stimulation (TMS) across ten northeastern and midwestern states, effective August 9, 2026. It will govern Part

The introduction of LCD for HLA-DQB1*06:02 testing for narcolepsy may affect billing practices by requiring updated coding and documentation specific to the new guidelines. Providers will need to fami

The new LCD for Transcranial Magnetic Stimulation (TMS) will outline coverage specifics which may influence the billing practices for Neurology specialists. Providers should prepare for potential adju

The new LCD for Transcranial Magnetic Stimulation (TMS) by Noridian could significantly impact billing practices for Neurology specialists. Effective from 08/20/2023, providers need to ensure complian

The new LCD for Somatosensory Testing establishes specific guidelines that may affect reimbursement rates for this service. Providers will need to ensure they meet the outlined criteria to secure prop

The introduction of the MRgFUS system for neurologic conditions may significantly impact billing practices due to its innovative approach and potential for improved patient outcomes. As this technolog

The implementation of MRgFUS for treating Essential Tremor and tremor-dominant Parkinson's Disease is affecting compliance updates. It opens the door for additional reimbursements under Medica

The upcoming LCD for Polysomnography and Other Sleep Studies may significantly influence billing practices, as it will provide updated indications and coverage criteria for sleep study services. Provi

The introduction of the Computed Tomography Cerebral Perfusion Analysis (CTP) under Noridian may increase compliance updates for neurological evaluations. Providers should ensure proper documentati

The introduction of MRgFUS for treating essential tremor and tremor dominant Parkinson's disease may lead to increased compliance updates for facilities that provide this service. As reimbursement

The LCD for Polysomnography and Other Sleep Studies by Noridian will likely impact billing practices by providing updated guidelines and criteria on the utilization of sleep study tests. Providers wil

The new LCD for Nerve Conduction Studies and Electromyography will have significant billing implications for practices performing these services. Providers will need to closely adhere to the updated g

The introduction of Autonomic Function Testing as a covered service will likely enhance compliance updates for providers in Neurology, who can now integrate this test into their diagnostic protocol

The LCD for Nerve Conduction Studies and Electromyography emphasizes the need for proper documentation and adherence to indicated criteria for reimbursement. As such, providers must ensure compliance

The new LCD on Automated Detection and Quantification of Brain MRIs is projected to supports compliance with updated rates processes by providing clear guidelines for billing these advanced imaging services. Providers