Local Coverage Article Billing and Coding

Billing and Coding: Spinal Cord Stimulation (Dorsal Column Stimulation)

A57023

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Contractor Information

Article Information

General Information

Article ID
A57023
Article Title
Billing and Coding: Spinal Cord Stimulation (Dorsal Column Stimulation)
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
09/26/2019
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Internet Only Manuals (IOM) Citations:

  • CMS IOM Publication 100-03, Medicare National Coverage Determinations NCD) Manual,
    • Chapter 1, Part 2, Section 160.7 Electrical Nerve Stimulators.
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in LCDs.

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.
  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35450, Spinal Cord Stimulation (Dorsal Column Stimulation). Please refer to the LCD for reasonable and necessary requirements.

Generally, CPT codes 95970, 95971, and 95972 should not be reported at a frequency more often than once every 30 days. Refer to the related LCD for additional information.

Coding Guidance:

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Note: The following CPT/HCPCS codes associated with the services outlined in this policy will not have diagnosis limitations applied at this time: 63661, 63662, 63663, 63664, 95970, 95971, 95972, L8681, L8682, L8683, L8685, L8686, L8687, L8688, L8689, L8695 and L8699.

Group 1 Codes
CodeDescription
63650 Implant neuroelectrodes
63655 Implant neuroelectrodes
63685 Insrt/redo spine n generator

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(4 Codes)
Group 1 Paragraph

Note: It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Dual diagnosis requirement: Claims submitted for spinal cord stimulation must include both a primary ICD-10-CM diagnosis code indicating the reason for the procedure and a secondary ICD-10-CM diagnosis code indicating the etiology of the chronic pain.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes 63650, 63655 and 63685:

Primary Diagnosis Codes

Group 1 Codes
CodeDescription
G89.21 Chronic pain due to trauma
G89.28 Other chronic postprocedural pain
G89.3 Neoplasm related pain (acute) (chronic)
G89.4 Chronic pain syndrome

Group 2

(432 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following are required Secondary Diagnosis Codes for CPT/HCPCS codes 63650, 63655 and 63685:

Group 2 Codes
CodeDescription
B02.0 Zoster encephalitis
B02.22 Postherpetic trigeminal neuralgia
B02.29 Other postherpetic nervous system involvement
G03.9 Meningitis, unspecified
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.6 Phantom limb syndrome with pain
G54.7 Phantom limb syndrome without pain
G54.8 Other nerve root and plexus disorders
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.40 Causalgia of unspecified upper limb
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G56.80 Other specified mononeuropathies of unspecified upper limb
G56.81 Other specified mononeuropathies of right upper limb
G56.82 Other specified mononeuropathies of left upper limb
G56.83 Other specified mononeuropathies of bilateral upper limbs
G56.90 Unspecified mononeuropathy of unspecified upper limb
G56.91 Unspecified mononeuropathy of right upper limb
G56.92 Unspecified mononeuropathy of left upper limb
G56.93 Unspecified mononeuropathy of bilateral upper limbs
G57.70 Causalgia of unspecified lower limb
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G57.80 Other specified mononeuropathies of unspecified lower limb
G57.81 Other specified mononeuropathies of right lower limb
G57.82 Other specified mononeuropathies of left lower limb
G57.83 Other specified mononeuropathies of bilateral lower limbs
G57.90 Unspecified mononeuropathy of unspecified lower limb
G57.91 Unspecified mononeuropathy of right lower limb
G57.92 Unspecified mononeuropathy of left lower limb
G57.93 Unspecified mononeuropathy of bilateral lower limbs
G58.0 Intercostal neuropathy
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.519 Complex regional pain syndrome I of unspecified upper limb
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.529 Complex regional pain syndrome I of unspecified lower limb
G90.59 Complex regional pain syndrome I of other specified site
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.23 Other spondylosis with radiculopathy, cervicothoracic region
M47.24 Other spondylosis with radiculopathy, thoracic region
M47.25 Other spondylosis with radiculopathy, thoracolumbar region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M50.10 Cervical disc disorder with radiculopathy, unspecified cervical region
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.13 Cervical disc disorder with radiculopathy, cervicothoracic region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.30 Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40 Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M96.1 Postlaminectomy syndrome, not elsewhere classified
S14.0XXA - S14.0XXS Concussion and edema of cervical spinal cord, initial encounter - Concussion and edema of cervical spinal cord, sequela
S14.101A - S14.101S Unspecified injury at C1 level of cervical spinal cord, initial encounter - Unspecified injury at C1 level of cervical spinal cord, sequela
S14.102A - S14.102S Unspecified injury at C2 level of cervical spinal cord, initial encounter - Unspecified injury at C2 level of cervical spinal cord, sequela
S14.103A - S14.103S Unspecified injury at C3 level of cervical spinal cord, initial encounter - Unspecified injury at C3 level of cervical spinal cord, sequela
S14.104A - S14.104S Unspecified injury at C4 level of cervical spinal cord, initial encounter - Unspecified injury at C4 level of cervical spinal cord, sequela
S14.105A - S14.105S Unspecified injury at C5 level of cervical spinal cord, initial encounter - Unspecified injury at C5 level of cervical spinal cord, sequela
S14.106A - S14.106S Unspecified injury at C6 level of cervical spinal cord, initial encounter - Unspecified injury at C6 level of cervical spinal cord, sequela
S14.107A - S14.107S Unspecified injury at C7 level of cervical spinal cord, initial encounter - Unspecified injury at C7 level of cervical spinal cord, sequela
S14.108A - S14.108S Unspecified injury at C8 level of cervical spinal cord, initial encounter - Unspecified injury at C8 level of cervical spinal cord, sequela
S14.109A - S14.109S Unspecified injury at unspecified level of cervical spinal cord, initial encounter - Unspecified injury at unspecified level of cervical spinal cord, sequela
S14.111A - S14.111S Complete lesion at C1 level of cervical spinal cord, initial encounter - Complete lesion at C1 level of cervical spinal cord, sequela
S14.112A - S14.112S Complete lesion at C2 level of cervical spinal cord, initial encounter - Complete lesion at C2 level of cervical spinal cord, sequela
S14.113A - S14.113S Complete lesion at C3 level of cervical spinal cord, initial encounter - Complete lesion at C3 level of cervical spinal cord, sequela
S14.114A - S14.114S Complete lesion at C4 level of cervical spinal cord, initial encounter - Complete lesion at C4 level of cervical spinal cord, sequela
S14.115A - S14.115S Complete lesion at C5 level of cervical spinal cord, initial encounter - Complete lesion at C5 level of cervical spinal cord, sequela
S14.116A - S14.116S Complete lesion at C6 level of cervical spinal cord, initial encounter - Complete lesion at C6 level of cervical spinal cord, sequela
S14.117A - S14.117S Complete lesion at C7 level of cervical spinal cord, initial encounter - Complete lesion at C7 level of cervical spinal cord, sequela
S14.118A - S14.118S Complete lesion at C8 level of cervical spinal cord, initial encounter - Complete lesion at C8 level of cervical spinal cord, sequela
S14.119A - S14.119S Complete lesion at unspecified level of cervical spinal cord, initial encounter - Complete lesion at unspecified level of cervical spinal cord, sequela
S14.121A - S14.121S Central cord syndrome at C1 level of cervical spinal cord, initial encounter - Central cord syndrome at C1 level of cervical spinal cord, sequela
S14.122A - S14.122S Central cord syndrome at C2 level of cervical spinal cord, initial encounter - Central cord syndrome at C2 level of cervical spinal cord, sequela
S14.123A - S14.123S Central cord syndrome at C3 level of cervical spinal cord, initial encounter - Central cord syndrome at C3 level of cervical spinal cord, sequela
S14.124A - S14.124S Central cord syndrome at C4 level of cervical spinal cord, initial encounter - Central cord syndrome at C4 level of cervical spinal cord, sequela
S14.125A - S14.125S Central cord syndrome at C5 level of cervical spinal cord, initial encounter - Central cord syndrome at C5 level of cervical spinal cord, sequela
S14.126A - S14.126S Central cord syndrome at C6 level of cervical spinal cord, initial encounter - Central cord syndrome at C6 level of cervical spinal cord, sequela
S14.127A - S14.127S Central cord syndrome at C7 level of cervical spinal cord, initial encounter - Central cord syndrome at C7 level of cervical spinal cord, sequela
S14.128A - S14.128S Central cord syndrome at C8 level of cervical spinal cord, initial encounter - Central cord syndrome at C8 level of cervical spinal cord, sequela
S14.129A - S14.129S Central cord syndrome at unspecified level of cervical spinal cord, initial encounter - Central cord syndrome at unspecified level of cervical spinal cord, sequela
S14.131A - S14.131S Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C1 level of cervical spinal cord, sequela
S14.132A - S14.132S Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C2 level of cervical spinal cord, sequela
S14.133A - S14.133S Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C3 level of cervical spinal cord, sequela
S14.134A - S14.134S Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C4 level of cervical spinal cord, sequela
S14.135A - S14.135S Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C5 level of cervical spinal cord, sequela
S14.136A - S14.136S Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C6 level of cervical spinal cord, sequela
S14.137A - S14.137S Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C7 level of cervical spinal cord, sequela
S14.138A - S14.138S Anterior cord syndrome at C8 level of cervical spinal cord, initial encounter - Anterior cord syndrome at C8 level of cervical spinal cord, sequela
S14.139A - S14.139S Anterior cord syndrome at unspecified level of cervical spinal cord, initial encounter - Anterior cord syndrome at unspecified level of cervical spinal cord, sequela
S14.141A - S14.141S Brown-Sequard syndrome at C1 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C1 level of cervical spinal cord, sequela
S14.142A - S14.142S Brown-Sequard syndrome at C2 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C2 level of cervical spinal cord, sequela
S14.143A - S14.143S Brown-Sequard syndrome at C3 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C3 level of cervical spinal cord, sequela
S14.144A - S14.144S Brown-Sequard syndrome at C4 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C4 level of cervical spinal cord, sequela
S14.145A - S14.145S Brown-Sequard syndrome at C5 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C5 level of cervical spinal cord, sequela
S14.146A - S14.146S Brown-Sequard syndrome at C6 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C6 level of cervical spinal cord, sequela
S14.147A - S14.147S Brown-Sequard syndrome at C7 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C7 level of cervical spinal cord, sequela
S14.148A - S14.148S Brown-Sequard syndrome at C8 level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at C8 level of cervical spinal cord, sequela
S14.149A - S14.149S Brown-Sequard syndrome at unspecified level of cervical spinal cord, initial encounter - Brown-Sequard syndrome at unspecified level of cervical spinal cord, sequela
S14.151A - S14.151S Other incomplete lesion at C1 level of cervical spinal cord, initial encounter - Other incomplete lesion at C1 level of cervical spinal cord, sequela
S14.152A - S14.152S Other incomplete lesion at C2 level of cervical spinal cord, initial encounter - Other incomplete lesion at C2 level of cervical spinal cord, sequela
S14.153A - S14.153S Other incomplete lesion at C3 level of cervical spinal cord, initial encounter - Other incomplete lesion at C3 level of cervical spinal cord, sequela
S14.154A - S14.154S Other incomplete lesion at C4 level of cervical spinal cord, initial encounter - Other incomplete lesion at C4 level of cervical spinal cord, sequela
S14.155A - S14.155S Other incomplete lesion at C5 level of cervical spinal cord, initial encounter - Other incomplete lesion at C5 level of cervical spinal cord, sequela
S14.156A - S14.156S Other incomplete lesion at C6 level of cervical spinal cord, initial encounter - Other incomplete lesion at C6 level of cervical spinal cord, sequela
S14.157A - S14.157S Other incomplete lesion at C7 level of cervical spinal cord, initial encounter - Other incomplete lesion at C7 level of cervical spinal cord, sequela
S14.158A - S14.158S Other incomplete lesion at C8 level of cervical spinal cord, initial encounter - Other incomplete lesion at C8 level of cervical spinal cord, sequela
S14.159A - S14.159S Other incomplete lesion at unspecified level of cervical spinal cord, initial encounter - Other incomplete lesion at unspecified level of cervical spinal cord, sequela
S14.2XXA - S14.2XXS Injury of nerve root of cervical spine, initial encounter - Injury of nerve root of cervical spine, sequela
S14.3XXA - S14.3XXS Injury of brachial plexus, initial encounter - Injury of brachial plexus, sequela
S24.0XXA - S24.0XXS Concussion and edema of thoracic spinal cord, initial encounter - Concussion and edema of thoracic spinal cord, sequela
S24.101A - S24.101S Unspecified injury at T1 level of thoracic spinal cord, initial encounter - Unspecified injury at T1 level of thoracic spinal cord, sequela
S24.102A - S24.102S Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter - Unspecified injury at T2-T6 level of thoracic spinal cord, sequela
S24.103A - S24.103S Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter - Unspecified injury at T7-T10 level of thoracic spinal cord, sequela
S24.104A - S24.104S Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter - Unspecified injury at T11-T12 level of thoracic spinal cord, sequela
S24.109A - S24.109S Unspecified injury at unspecified level of thoracic spinal cord, initial encounter - Unspecified injury at unspecified level of thoracic spinal cord, sequela
S24.111A - S24.111S Complete lesion at T1 level of thoracic spinal cord, initial encounter - Complete lesion at T1 level of thoracic spinal cord, sequela
S24.112A - S24.112S Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter - Complete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.113A - S24.113S Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter - Complete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.114A - S24.114S Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter - Complete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.119A - S24.119S Complete lesion at unspecified level of thoracic spinal cord, initial encounter - Complete lesion at unspecified level of thoracic spinal cord, sequela
S24.131A - S24.131S Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter - Anterior cord syndrome at T1 level of thoracic spinal cord, sequela
S24.132A - S24.132S Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter - Anterior cord syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.133A - S24.133S Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter - Anterior cord syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.134A - S24.134S Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter - Anterior cord syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.139A - S24.139S Anterior cord syndrome at unspecified level of thoracic spinal cord, initial encounter - Anterior cord syndrome at unspecified level of thoracic spinal cord, sequela
S24.141A - S24.141S Brown-Sequard syndrome at T1 level of thoracic spinal cord, initial encounter - Brown-Sequard syndrome at T1 level of thoracic spinal cord, sequela
S24.142A - S24.142S Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, initial encounter - Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.143A - S24.143S Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, initial encounter - Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.144A - S24.144S Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, initial encounter - Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.149A - S24.149S Brown-Sequard syndrome at unspecified level of thoracic spinal cord, initial encounter - Brown-Sequard syndrome at unspecified level of thoracic spinal cord, sequela
S24.151A - S24.151S Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter - Other incomplete lesion at T1 level of thoracic spinal cord, sequela
S24.152A - S24.152S Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter - Other incomplete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.153A - S24.153S Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter - Other incomplete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.154A - S24.154S Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter - Other incomplete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.159A - S24.159S Other incomplete lesion at unspecified level of thoracic spinal cord, initial encounter - Other incomplete lesion at unspecified level of thoracic spinal cord, sequela
S24.2XXA - S24.2XXS Injury of nerve root of thoracic spine, initial encounter - Injury of nerve root of thoracic spine, sequela
S34.01XA - S34.01XS Concussion and edema of lumbar spinal cord, initial encounter - Concussion and edema of lumbar spinal cord, sequela
S34.02XA - S34.02XS Concussion and edema of sacral spinal cord, initial encounter - Concussion and edema of sacral spinal cord, sequela
S34.101A - S34.101S Unspecified injury to L1 level of lumbar spinal cord, initial encounter - Unspecified injury to L1 level of lumbar spinal cord, sequela
S34.102A - S34.102S Unspecified injury to L2 level of lumbar spinal cord, initial encounter - Unspecified injury to L2 level of lumbar spinal cord, sequela
S34.103A - S34.103S Unspecified injury to L3 level of lumbar spinal cord, initial encounter - Unspecified injury to L3 level of lumbar spinal cord, sequela
S34.104A - S34.104S Unspecified injury to L4 level of lumbar spinal cord, initial encounter - Unspecified injury to L4 level of lumbar spinal cord, sequela
S34.105A - S34.105S Unspecified injury to L5 level of lumbar spinal cord, initial encounter - Unspecified injury to L5 level of lumbar spinal cord, sequela
S34.109A - S34.109S Unspecified injury to unspecified level of lumbar spinal cord, initial encounter - Unspecified injury to unspecified level of lumbar spinal cord, sequela
S34.111A - S34.111S Complete lesion of L1 level of lumbar spinal cord, initial encounter - Complete lesion of L1 level of lumbar spinal cord, sequela
S34.112A - S34.112S Complete lesion of L2 level of lumbar spinal cord, initial encounter - Complete lesion of L2 level of lumbar spinal cord, sequela
S34.113A - S34.113S Complete lesion of L3 level of lumbar spinal cord, initial encounter - Complete lesion of L3 level of lumbar spinal cord, sequela
S34.114A - S34.114S Complete lesion of L4 level of lumbar spinal cord, initial encounter - Complete lesion of L4 level of lumbar spinal cord, sequela
S34.115A - S34.115S Complete lesion of L5 level of lumbar spinal cord, initial encounter - Complete lesion of L5 level of lumbar spinal cord, sequela
S34.119A - S34.119S Complete lesion of unspecified level of lumbar spinal cord, initial encounter - Complete lesion of unspecified level of lumbar spinal cord, sequela
S34.121A - S34.121S Incomplete lesion of L1 level of lumbar spinal cord, initial encounter - Incomplete lesion of L1 level of lumbar spinal cord, sequela
S34.122A - S34.122S Incomplete lesion of L2 level of lumbar spinal cord, initial encounter - Incomplete lesion of L2 level of lumbar spinal cord, sequela
S34.123A - S34.123S Incomplete lesion of L3 level of lumbar spinal cord, initial encounter - Incomplete lesion of L3 level of lumbar spinal cord, sequela
S34.124A - S34.124S Incomplete lesion of L4 level of lumbar spinal cord, initial encounter - Incomplete lesion of L4 level of lumbar spinal cord, sequela
S34.125A - S34.125S Incomplete lesion of L5 level of lumbar spinal cord, initial encounter - Incomplete lesion of L5 level of lumbar spinal cord, sequela
S34.129A - S34.129S Incomplete lesion of unspecified level of lumbar spinal cord, initial encounter - Incomplete lesion of unspecified level of lumbar spinal cord, sequela
S34.131A - S34.131S Complete lesion of sacral spinal cord, initial encounter - Complete lesion of sacral spinal cord, sequela
S34.132A - S34.132S Incomplete lesion of sacral spinal cord, initial encounter - Incomplete lesion of sacral spinal cord, sequela
S34.139A - S34.139S Unspecified injury to sacral spinal cord, initial encounter - Unspecified injury to sacral spinal cord, sequela
S34.21XA - S34.21XS Injury of nerve root of lumbar spine, initial encounter - Injury of nerve root of lumbar spine, sequela
S34.22XA - S34.22XS Injury of nerve root of sacral spine, initial encounter - Injury of nerve root of sacral spine, sequela
S34.3XXA - S34.3XXS Injury of cauda equina, initial encounter - Injury of cauda equina, sequela
S34.4XXA - S34.4XXS Injury of lumbosacral plexus, initial encounter - Injury of lumbosacral plexus, sequela
T85.112A - T85.112S Breakdown (mechanical) of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter - Breakdown (mechanical) of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.113A - T85.113S Breakdown (mechanical) of implanted electronic neurostimulator, generator, initial encounter - Breakdown (mechanical) of implanted electronic neurostimulator, generator, sequela
T85.122A - T85.122S Displacement of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter - Displacement of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.123A - T85.123S Displacement of implanted electronic neurostimulator, generator, initial encounter - Displacement of implanted electronic neurostimulator, generator, sequela
T85.192A - T85.192S Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter - Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.193A - T85.193S Other mechanical complication of implanted electronic neurostimulator, generator, initial encounter - Other mechanical complication of implanted electronic neurostimulator, generator, sequela
Z45.42 Encounter for adjustment and management of neurostimulator

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this Article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


CodeDescription
036X Operating Room Services - General Classification

Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
09/26/2019 R2

Article revised and published on 10/14/2021 to reflect the removal of outlined codes that were listed under “ICD-10-CM Codes that DO NOT Support Medical Necessity” as only the codes listed under “ICD-10-CM Codes that Support Medical Necessity” are appropriate for coding and billing. Minor formatting changes have also been made.

09/26/2019 R1

Article revised and published on 09/26/2019 to indicate the following ICD-10 codes have been added to the ICD-10 Codes that Support Medical Necessity Group 2 Codes for dates of service 7/23/2019 and after: T85.112 A-S, T85.113 A-S, T85.122 A-S, T85.123 A-S, T85.192 A-S and T85.193 A-S and Z45.42. Also, slight formatting changes have been made.

Associated Documents

Related National Coverage Documents
NCDs
160.7 - Electrical Nerve Stimulators
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
10/08/2021 09/26/2019 - N/A Currently in Effect You are here
09/20/2019 09/26/2019 - N/A Superseded View
09/19/2019 09/26/2019 - N/A Superseded View

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