Local Coverage Article Billing and Coding

Billing and Coding: Spinal Cord Stimulators for Chronic Pain

A56876

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Article Information

General Information

Article ID
A56876
Article Title
Billing and Coding: Spinal Cord Stimulators for Chronic Pain
Article Type
Billing and Coding
Original Effective Date
08/22/2019
Revision Effective Date
05/13/2021
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 2022 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 which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Spinal Cord Stimulators for Chronic Pain L37632.

Indications

This A/B MAC will reimburse for placement of a maximum of 2 leads or 16 contacts, and for 2 spinal cord stimulator (SCS) trials per anatomic spinal region per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology).

If a trial fails, a repeat trial is not appropriate, unless there are extenuating circumstances that lead to trial failure. Appropriate medical documentation to support a repeat trial can be sent on appeal. Generally, electronic analysis services (CPT® codes 95970, 95971 and 95972) are not considered medically necessary, when provided at a frequency more often than once every 30 days. More frequent analysis may be necessary in the first month after implantation.

CPT® code 63650 - 2 temporary spinal cord stimulator trials per anatomic spinal region (2 per date of service (DOS)) or (4 units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ambulatory surgery center (ASC), outpatient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, outpatient hospital, or hospital.

CPT® code 63655 - 1 permanent spinal cord stimulator per patient per lifetime and must be performed in an ASC, outpatient hospital or hospital.

CPT® codes 63661 and 63663 - Will not be reimbursed in the office setting since they are included in 63650.

The HCPCS/CPT® code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Coding Information

CPT/HCPCS Codes

Group 1

(12 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
63650 Implant neuroelectrodes
63655 Implant neuroelectrodes
63661 Remove spine eltrd perq aray
63662 Remove spine eltrd plate
63663 Revise spine eltrd perq aray
63664 Revise spine eltrd plate
63685 Insrt/redo spine n generator
63688 Revise/remove neuroreceiver
95970 Alys npgt w/o prgrmg
95971 Alys smpl sp/pn npgt w/prgrm
95972 Alys cplx sp/pn npgt w/prgrm
L8680 Implt neurostim elctr each

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
XX000 Not Applicable

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

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.

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.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
05/13/2021 R4

Under CMS National Coverage Policy added description to regulation and moved regulation CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §160.7 Electrical Nerve Stimulators to the related LCD. Formatting, punctuation and typographical errors were corrected throughout the article. Acronyms were defined where appropriate throughout the article.

01/01/2021 R3

Under CPT/HCPCS Codes Group 1: Codes changed descriptors for 63663 and 63664. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/17/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Spinal Cord Stimulators for Chronic Pain L37632 LCD and placed in this article. Acronyms were defined throughout the article. Under Article Text deleted the subheading Utilization Guidelines.

 

08/29/2019 R1

All coding located in the Coding Information section has been removed from the Spinal Cord Stimulators for Chronic Pain L37632 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L37632 - Spinal Cord Stimulators for Chronic Pain
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
05/04/2021 05/13/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Spinal Cord
  • Chronic Pain