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Chapter 4
Section 20.2
Stereotactic
Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment
Of Parkinson’s Disease
Issue Date: July 8, 1998
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT PROCEDURE CODE
61720
2.0 DESCRIPTION
Pallidotomy is a neurosurgical
procedure involving a surgical lesion of the globus pallidus, which
lies in the basal ganglia portion of the brain, with the aim of
controlling one or more of the major symptoms of parkinsonism, including
tremor, rigidity, and hypokinesia, in those patients who have not responded
adequately to medical treatment.
3.0 POLICY
Pallidotomy for Parkinson’s
disease may be cost-shared when the patient has a diagnosis of idiopathic
Parkinson’s disease.
4.0 EXCLUSIONS
4.1 Patients
exhibiting signs of early dementia.
4.2 Elderly
patients with very advanced disease, autonomic symptoms, severe
speech impairment.
4.3 Patients
with “Parkinson’s Plus” syndrome which mimic true Parkinson’s disease,
e.g., postural instability, freezing, poor speech volume and swallowing
difficulties.
5.0 EFFECTIVE DATE
November 1, 1996.
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