LCD Reference Article Billing and Coding Article

Billing and Coding: Peripheral Nerve Stimulation

A55531

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A55531
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Peripheral Nerve Stimulation
Article Type
Billing and Coding
Original Effective Date
08/27/2018
Revision Effective Date
01/01/2024
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 2023 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.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e). Prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Article Guidance

Article Text

The following billing and coding guidance is to be used with its associated Local Coverage Determination.

Noridian has found the current peer-reviewed data is insufficient to warrant the medical necessity of coverage for Peripheral Nerve Field Stimulation (PNFS), also known as Peripheral Subcutaneous Field Stimulation (PSFS) for any condition. Therefore, this service will not be covered for any condition.

To bill for denial, providers must bill CPT® code 64999 for both the trial and permanent insertion of the electrode array when billing for these procedures and report the following information.

Part B claims

  • Enter 1 units of service (UOS)
  • Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT® code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:
    • Loop 2400 or SV101-7 for the 5010A1 837P
    • Item 19 for paper claim

Part A claims

  • Enter 1 UOS
  • Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT® code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:
    • Line SV02-7 for 837I electronic claim
    • Block 80 on the UB04 claim form

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(15 Codes)
Group 1 Paragraph

Providers are to use CPT® Code 64999 for both the trial and permanent insertion of the electrode array when billing for the procedures associated with either Peripheral Subcutaneous Field Stimulation or Peripheral Nerve Field Stimulation. 64999 for these purposes is not covered due to insufficient peer reviewed data to warrant the medical necessity of coverage.

Group 1 Codes
Code Description
61885 INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO A SINGLE ELECTRODE ARRAY
64553 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; CRANIAL NERVE
64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE)
64561 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
64569 REVISION OR REPLACEMENT OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR
64570 REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR
64575 OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE)
64581 OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT)
64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
64590 INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
64595 REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
64596 INSERTION OR REPLACEMENT OF PERCUTANEOUS ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED; INITIAL ELECTRODE ARRAY
64597 INSERTION OR REPLACEMENT OF PERCUTANEOUS ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED; EACH ADDITIONAL ELECTRODE ARRAY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64598 REVISION OR REMOVAL OF NEUROSTIMULATOR ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(53 Codes)
Group 1 Paragraph

Group 1 codes do not apply to CPT® code 64585 for the purposes of this policy.

Group 1 Codes
Code Description
B02.0 Zoster encephalitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.29 Other postherpetic nervous system involvement
E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
G43.011 Migraine without aura, intractable, with status migrainosus
G43.019 Migraine without aura, intractable, without status migrainosus
G43.111 Migraine with aura, intractable, with status migrainosus
G43.A1 Cyclical vomiting, in migraine, intractable
G43.B1 Ophthalmoplegic migraine, intractable
G43.C1 Periodic headache syndromes in child or adult, intractable
G43.D1 Abdominal migraine, intractable
G43.811 Other migraine, intractable, with status migrainosus
G43.819 Other migraine, intractable, without status migrainosus
G43.E11 Chronic migraine with aura, intractable, with status migrainosus
G43.E19 Chronic migraine with aura, intractable, without status migrainosus
G44.021 Chronic cluster headache, intractable
G44.029 Chronic cluster headache, not intractable
G44.321 Chronic post-traumatic headache, intractable
G44.329 Chronic post-traumatic headache, not intractable
G44.59 Other complicated headache syndrome
G44.86 Cervicogenic headache
G50.0 Trigeminal neuralgia
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G54.8 Other nerve root and plexus disorders
G54.9 Nerve root and plexus disorder, unspecified
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G58.8 Other specified mononeuropathies
G58.9 Mononeuropathy, unspecified
G59 Mononeuropathy in diseases classified elsewhere
G89.22 Chronic post-thoracotomy pain
G90.50 Complex regional pain syndrome I, unspecified
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
G90.521 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
G90.59 Complex regional pain syndrome I of other specified site
M54.81 Occipital neuralgia
N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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.

Code Description
999x Not Applicable
N/A

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.

9999
Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R6

Per 2024 CPT/HCPCS Updates:

The following codes were added to the Group 1 Codes: 64596, 64597, 64598

Either the short and/or long code description was changed for the following code(s). Please Note: Depending on which descriptor was used, there may not be any changes to the code display in this document: 64585, 64590, 64595

This update is effective 01/01/2024.

10/01/2023 R5

Updated to indicate this article is an LCD Reference Article.

10/01/2023 R4

Per Annual ICD-10 Updates:

The following codes were added to Group 1: G43.E11, G43.E19

01/01/2023 R3

Per 2023 CPT/HCPCS updates, either the long or short description of CPT codes 64999 has been updated. 

10/01/2021 R2

Added the diagnosis code G44.86 – Cervicogenic headache per the Annual ICD-10-CM Update effective 10/01/2021.

12/01/2019 R1

This article was converted to a Billing and Coding Article type and is to be used with its associated Local Coverage Determination.

The article title was changed to from "Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing" to "Billing and Coding: Peripheral Nerve Stimulation" to match the title of the LCD.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37360 - Peripheral Nerve Stimulation
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/19/2023 01/01/2024 - N/A Currently in Effect You are here
11/08/2023 10/01/2023 - 12/31/2023 Superseded View
08/24/2023 10/01/2023 - N/A Superseded View
12/16/2022 01/01/2023 - 09/30/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Part A
  • Part B
  • electronic claim form
  • Peripheral
  • Nerve
  • Field
  • Stimulation
  • Item 19
  • UB04
  • 64999