Neurosurgery: funding brain and spine surgery in Georgia and abroad

What does neurosurgery cover and who decides on the treatment?

Neurosurgery is the branch of surgery that treats diseases and injuries of the brain, spinal cord, spine and peripheral nerves. Its scope includes, for example, brain and spinal cord tumours, intracranial haemorrhage and aneurysm, hydrocephalus, herniated spinal discs and spinal canal stenosis, head and spinal trauma, and in some cases surgical treatment of epilepsy and movement disorders. The same diagnosis is sometimes treated surgically and sometimes conservatively, with radiotherapy or with an endovascular method.

Emergency neurosurgery: what does the Universal Healthcare Programme cover?

The Universal Healthcare Programme (Government Resolution No. 36 of 2013) defines emergency surgical services through a table of ICD-10 diagnoses and NCSP procedures, and the main neurosurgical emergencies are listed separately in that table:

• Intracranial trauma: traumatic cerebral oedema and focal brain injury with decompressive craniotomy, evacuation of epidural and acute subdural haematomas, operations for fractures of the skull vault and base;
• Non-traumatic conditions: intracerebral haemorrhage with evacuation of the haematoma, brain compression and cerebral oedema;
• Spine and spinal cord: stabilisation of cervical, thoracic and lumbar vertebral fractures, operations on the spinal cord and nerve roots in trauma.

The list of critical conditions whose management is funded without a co-payment includes intracerebral haemorrhage with impaired consciousness, cerebral infarction, status epilepticus and anoxic brain injury. In an emergency the family submits nothing to the Agency: the clinic makes the notification, and the family's task is to provide the patient's identity details as early as possible. The co-payment share for other emergency hospitalisations varies by category and is given in the table in the Universal Healthcare Programme guide.

If the patient is in a regional hospital and needs to be transferred to another city for neurosurgery, the doctors choose the transfer format. When an ordinary ambulance is not enough, we work as described on the intensive care team page.

Planned surgery: approval letter, limit and co-payment

Planned neurosurgery, such as an operation for a herniated disc, stenosis, a benign growth or shunting, is funded under the programme's planned surgery component. This means three things. First, an approval letter from the National Health Agency is needed before the operation, and the clinic usually requests it through the electronic system. Second, an annual limit applies, covering all planned operations carried out in one year. Third, your co-payment share is set by your category, with an upper cap.

In neurosurgery a large part of the cost often comes from implants and specific consumables: spinal fixation systems, shunts, navigation or neuromonitoring services. So ask the clinic for a written cost estimate that shows separately the programme's share, your co-payment and any additional charge, and ask which rule permits that additional charge. A clinic may charge more than the set co-payment for a programme service only in cases permitted by an act of the Minister.

If the total cost exceeds the limit or the co-payment is more than the family can bear, the Agency's written reply is your ticket to the next level: City Hall often calculates the amount of the co-payment, and the referral commission sees what remained unfunded. The right order of sources is described in the guide to funding an operation.

Brain or spinal cord tumour: when do the oncology rules apply?

Surgery, chemotherapy and radiotherapy for a malignant tumour are part of the Universal Healthcare Programme's oncology services, which people keep even if they are not entitled to the basic package because of private insurance or a high income. In the standard package, cancer surgery for patients under 18 has no co-payment. The full route for a cancer patient, from medicines to the cancer registry, is in the guide to cancer treatment funding.

In neurosurgery one detail is often unclear: many brain growths, for example meningioma, are histologically benign and are coded in ICD-10 outside the group of malignant neoplasms. In such cases, whether the case goes under the oncology or the general planned surgery rules depends on the diagnosis code, which in turn changes the limit and the co-payment. Ask the clinic to state in writing under which component and with which code it submitted the case.

In children, a brain tumour also opens a separate route: treatment of cancer patients under 18 at the Solidarity Fund of Georgia's partner clinics abroad is part of the individual component of the Referral Services Programme. The conditions and documents are in the guide to funding a child's treatment.

Funding sources in one table

The 2026 state healthcare programmes (Government Resolution No. 655, version of 7 October 2026) have no separate programme for neurosurgery or neurological rehabilitation; neurosurgery is funded through the general channels listed above.

When is neurosurgery abroad considered?

Families usually consider surgery abroad when a tumour or vascular lesion is in a hard-to-reach location, when a technology or expertise is needed that the local team itself recommends, or when two doctors' opinions contradict each other. Neurosurgery is a common area in our country guides: Germany, Turkey, Israel, India and France. The country should be chosen on the basis of the diagnosis and the specific team, not price alone.

To draw up a treatment plan and cost estimate, a foreign clinic usually needs: MRI and CT scans in DICOM format with their reports, a description of the neurological status, the histology report from a biopsy or previous operation, and a list of comorbidities and current medicines. In the cost estimate, ask separately for what comes after the operation: days in intensive care, a follow-up scan, the first stage of rehabilitation, because these are exactly the items that most often push the cost over budget.

If you are asking the state to fund treatment abroad, the commission first relies on a specialist expert's opinion on whether the same treatment can be provided in Georgia; this and the other conditions are in the guide to funding treatment abroad. After the operation, the timing and format of the flight must be confirmed by the surgeon; if a regular flight is not suitable, the route is described on the medical charter flight page. Our clinic search service can help you choose a clinic and communicate with it.

The document package: what to prepare and what to translate?

The same package is needed for a state application and for a foreign clinic, only in different languages. Put it together once and correctly:

• Form IV-100/a with the ICD-10 diagnosis and the NCSP procedure code: the basis for applications to the Agency, City Hall and the commission. Its translation is also useful for a foreign clinic.
• Discharge summaries from previous hospitalisations and operations, including the operative report; translation of discharge summaries from Georgian.
• Imaging: MRI, CT and angiography reports, and the images themselves on a disc or as files. The reports are translated as described under translation of imaging reports, while the images need no translation; why a photo of the screen is not enough is explained in the second opinion guide.
• Histology, if a biopsy or operation has already been done: the report and, if needed, the slides or block.
• Cost estimate and invoice itemised line by line; for a state application a foreign invoice is translated and notarised, which we do through translation of financial documents.
• Identity documents: passport, for a child the birth certificate and, if the child travels with one parent, the other parent's consent.

A document from a medical facility, including a private clinic, can be apostilled directly if the destination country requires it. What each country needs is shown by the Apostille or legalisation? tool, and an indicative price by the Translation price calculator. A step-by-step checklist is in the guide to documents for treatment abroad.

After the operation: rehabilitation, medicines and status

After neurosurgery the costs often do not end. Rehabilitation, follow-up MRI and long-term medication weigh on the family budget for a long time, so plan how to fund them before the operation:

1. Rehabilitation. The 2026 state programmes have no general neurological rehabilitation component; some municipalities fund rehabilitation under their own rules. Ask at City Hall, and when the patient is discharged, ask the clinic for a written rehabilitation plan, because the application will need it.
2. Medicines. Medicines for epilepsy and Parkinson's disease are covered for certain groups by a separate annex of the Universal Healthcare Programme; who is entitled and how is explained in the guide to medicine funding.
3. Status. If the operation leaves a long-term functional impairment, obtaining disability status changes the Universal Healthcare Programme package and the municipal limits; the procedure is in the social status guide.
4. Home care. A caregiver, medical equipment and nurse visits are arranged through the post-operative care service.

Ask for any refusal at any stage in writing: the deadline for an administrative complaint is one month, and the appeal structure is in the guide to appealing a refusal.

Frequently asked questions about funding neurosurgery