Intracranial neuromodulation for drug resistant epilepsy (DRE) has become widely adopted for patients with non-lesional disease, or in whom lesions cannot safely be resected or ablated. Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS) are FDA approved for patients above the age of 18. There is growing data of the safety and efficacy of these devices in the pediatric population as well. Due to the lack of FDA approval, many payers consider the “off-label” use of DBS or RNS in pediatric patients as “investigational,” and as such, will not approve their use. In these circumstances, letters of appeal can be instrumental in securing prior authorization. AES has gathered example appeal letters that can be tailored to individual patients to help increase access to these therapies.