Table 1.

Medical necessity criteria for the use of DBS for refractory OCD^*.

Chronicity	OCD Diagnosis for duration of at least 5 years
Severity	Y-BOCS ≥ 28
Functional Impairment	In at least one of the domains of: activities of daily living; social functioning; occupational functioning; thinking, concentration, and judgment; or ability to engage in other major life areas (34)
Treatment-refractoriness	Persistence of severe symptoms (Y-BOCS ≥ 28) despite:	Adequate trials (of at least 12-weeks in duration) of three serotonergic medications at FDA-maximum approved dosages or greater (one of which must be clomipramine) • The requirement for clomipramine may be excluded if the patient experiences adverse effects, does not tolerate the drug, or its use is otherwise contraindicated.
		The use of adjunctive pharmacological agents including a long-acting benzodiazepine and an antipsychotic. • The requirement for a benzodiazepine may be excluded if the patient has a history of substance use disorder or another contraindication to benzodiazepines
		Engagement in exposure therapy for at least 20 sessions with a clinician experienced in the treatment of OCD

^*Generally accepted standards evolve with time, with gains in medical knowledge and development of new treatment options. These criteria should not be considered static or immutable.