It has come to Novitas’ attention that auricular peripheral nerve stimulation has been billed to Medicare using the CPT code 64555. CPT code 64555 is described as: Percutaneous implantation of Neurostimulator electrode array; peripheral nerve (excludes sacral nerve).
Coding Guidance
Notice: It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.
Background:
The following devices are listed under the Food and Drug Administration (FDA) approval documents as electro-acupuncture devices used for stimulation of auricular acupuncture points and as such are non-covered. Acupuncture for stimulation of auricular points is not a covered Medicare benefit.
- NeuroStim system/NSS
- P-Stim
- ANSiStim
- E-Pulse
The following device is FDA classified as a percutaneous nerve stimulator for substance use disorders; Class II device:
This device is an electrical nerve stimulator (percutaneous nerve field stimulator [PNFS] system) that is placed behind the patient’s ear (auricular). The NSS-2 Bridge is described as nearly identical to the Electronic Auricular Device (EAD) for a different intended use (to aid in the reduction of opioid withdrawal symptoms). This device is non-covered by Medicare when used for acupuncture (stimulation of auricular acupuncture points) for any indication.
For additional information, please refer to National Coverage Determination (NCD) 30.3 for Acupuncture.
Coding Guidelines:
The CPT code 64555, does not describe the procedure of auricular acupuncture stimulation and it should be coded using the NOC CPT code 64999 - unlisted procedure, nervous system.
Reporting:
When billing for auricular peripheral nerve stimulation, use the NOC CPT code 64999 - unlisted procedure, nervous system. The term for the device used for this procedure (e.g. NeuroStim/NSS, P-Stim, ANSiStim, E-Pulse, Electro-Acupuncture, NSS-2 Bridge) should be reported in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B.
The service for auricular peripheral nerve stimulation (CPT code 64999) will be denied as non-covered. This service is not a covered Medicare benefit because acupuncture for auricular stimulation does not meet the definition of reasonable and necessary under Section 1862(a)(1) of the Act.
While the information given in this article is directed to Neurostim system/NSS, P-Stim, ANSiStim, E-Pulse, and NSS-2 Bridge, other current or future devices when used for the procedure auricular peripheral nerve stimulation or electro-acupuncture, would also be considered a non-covered service.
Documentation Requirements
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- 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.
- 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.
