LCD Reference Article Billing and Coding Article

Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea

A57092

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
National Government Services, Inc.	MAC - Part A	06101 - MAC A	J - 06	Illinois
National Government Services, Inc.	MAC - Part B	06102 - MAC B	J - 06	Illinois
National Government Services, Inc.	MAC - Part A	06201 - MAC A	J - 06	Minnesota
National Government Services, Inc.	MAC - Part B	06202 - MAC B	J - 06	Minnesota
National Government Services, Inc.	MAC - Part A	06301 - MAC A	J - 06	Wisconsin
National Government Services, Inc.	MAC - Part B	06302 - MAC B	J - 06	Wisconsin
National Government Services, Inc.	A and B and HHH MAC	13101 - MAC A	J - K	Connecticut
National Government Services, Inc.	A and B and HHH MAC	13102 - MAC B	J - K	Connecticut
National Government Services, Inc.	A and B and HHH MAC	13201 - MAC A	J - K	New York - Entire State
National Government Services, Inc.	A and B and HHH MAC	13202 - MAC B	J - K	New York - Downstate
National Government Services, Inc.	A and B and HHH MAC	13282 - MAC B	J - K	New York - Upstate
National Government Services, Inc.	A and B and HHH MAC	13292 - MAC B	J - K	New York - Queens
National Government Services, Inc.	A and B and HHH MAC	14111 - MAC A	J - K	Maine
National Government Services, Inc.	A and B and HHH MAC	14112 - MAC B	J - K	Maine
National Government Services, Inc.	A and B and HHH MAC	14211 - MAC A	J - K	Massachusetts
National Government Services, Inc.	A and B and HHH MAC	14212 - MAC B	J - K	Massachusetts
National Government Services, Inc.	A and B and HHH MAC	14311 - MAC A	J - K	New Hampshire
National Government Services, Inc.	A and B and HHH MAC	14312 - MAC B	J - K	New Hampshire
National Government Services, Inc.	A and B and HHH MAC	14411 - MAC A	J - K	Rhode Island
National Government Services, Inc.	A and B and HHH MAC	14412 - MAC B	J - K	Rhode Island
National Government Services, Inc.	A and B and HHH MAC	14511 - MAC A	J - K	Vermont
National Government Services, Inc.	A and B and HHH MAC	14512 - MAC B	J - K	Vermont

Article Information

General Information

Article ID
A57092

Article Title
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea

Article Type
Billing and Coding

Original Effective Date
04/01/2020

Revision Effective Date
01/01/2022

Revision Ending Date
N/A

Retirement Date
N/A

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

Refer to the Proposed Local Coverage Determination (LCD) L38387, Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and necessary requirements.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Coding Guidelines

Effective for dates of service on or after 01/01/2022, the following CPT codes should be used to report insertion, replacement and removal of hypoglossal nerve neurostimulator:

CPT code 64582 should be reported for insertion of hypoglossal nerve neurostimulator electrode, generator and breathing sensor electrode
CPT code 64583 should be used to report revision or replacement of hypoglossal nerve neurostimulator electrode and breathing sensor electrode with connection to existing generator

Reduced services-Use modifier 52 for revision or replacement of either the hypoglossal nerve stimulator electrode array or distal respiratory sensor, and bill at a reduced rate.

CPT code 64854 should be used to report removal of hypoglossal nerve neurostimulator electrode and generator and breathing sensor electrode

Reduced services- Use modifier 52 for removal of one or two components of the hypoglossal nerve stimulator electrode array, pulse generator, or distal respiratory sensor, and bill at a reduced rate.

For dates of service prior to 01/01/2022:

Implantation of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA utilizes 2 CPT codes:

CPT code 64568 - Incision for implantation of cranial nerve (eg: vagus nerve) neurostimulator electrode array and pulse generator
CPT code +0466T - Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (list separately in addition to code for primary procedure)

*Note: Per AMA CPT, use 0466T in conjunction with 64568

Revision or replacement of HSN for treatment of OSA is reported with:

CPT code 0467T - Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator

Removal of HSN for treatment of OSA is reported with:

CPT code 0468T - Removal of chest wall respiratory sensor electrode or electrode array

Coding Information

For dates of service on or after 01/01/2022, CPT codes 64582, 64853 and 64584 should be used to report hypoglossal nerve neurostimulation.

For dates of service prior to 01/01/2022:

CPT code 64568 is for both the neurostimulator and its corresponding electrode array
CPT codes 0466T, 0467T, and 0468T are codes for the insertion, revision or replacement, and removal respectively

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 diagnosis code(s).

Response To Comments

Number	Comment	Response
1

Coding Information

CPT/HCPCS Codes

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Group 1

(3 Codes)

Group 1 Paragraph

For dates of service on or after 01/01/2022, CPT codes 64582, 64853 and 64584 should be used to report hypoglossal nerve neurostimulation. At this time, CPT code 64584 will not have diagnosis code limitations applied.

For dates of service prior to 01/01/2022, the following CPT code (0468T) associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time.

Group 1 Codes

Code	Description
64582	OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
64583	REVISION OR REPLACEMENT OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR
64584	REMOVAL OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY

CPT/HCPCS Modifiers

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Group 1

(1 Code)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
52	REDUCED SERVICES: UNDER CERTAIN CIRCUMSTANCES A SERVICE OR PROCEDURE IS PARTIALLY REDUCED OR ELIMINATED AT THE PHYSICIAN'S DISCRETION. UNDER THESE CIRCUMSTANCES THE SERVICE PROVIDED CAN BE IDENTIFIED BY ITS USUAL PROCEDURE NUMBER AND THE ADDITION OF THE MODIFIER -52, SIGNIFYING THAT THE SERVICE IS REDUCED. THIS PROVIDES A MEANS OF REPORTING REDUCED SERVICES WITHOUT DISTURBING THE IDENTIFICATION OF THE BASIC SERVICE. MODIFIER CODE 09952 MAY BE USED AS AN ALTERNATIVE TO MODIFIER -52. NOTE: FOR HOSPITAL OUTPATIENT REPORTING OF A PREVIOUSLY SCHEDULED PROCEDURE/SERVICE THAT IS PARTIALLY REDUCED OR CANCELLED AS A RESULT OF EXTENUATING CIRCUMSTANCES OR THOSE THAT THREATEN THE WELL-BEING OF THE PATIENT PRIOR TO OR AFTER ADMINISTRATION OF ANESTHESIA, SEE MODIFIERS -73 AND -74 (SEE MODIFIERS APPROVED FOR ASC HOSPITAL OUTPATIENT USE).

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(1 Code)

Group 1 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.

Note: Dual diagnosis requirement
Coverage for hypoglossal nerve stimulation procedures on patients who meet coverage criteria set forth in LCD L38387 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 Body Mass Index (BMI) is less than 35 kg/m2 as set forth in the LCD Covered Indications. Report a primary diagnosis code from Group1 Codes and a secondary diagnosis code from Group 2 Codes below.

Effective for dates of service on or after 01/01/2022, CPT codes 64582 and 64583 should be reported for hypoglossal nerve neurostimulation.

Note: CPT code 64584 will have no diagnosis to procedure code restriction at this time.

For dates of service prior to 01/01/2022, Medicare is establishing the following limited coverage for CPT codes: 64568 (when reported with add on code 0466T) and for 0467T

Primary Diagnosis

Group 1 Codes

Code	Description
G47.33	Obstructive sleep apnea (adult) (pediatric)

Group 2

(16 Codes)

Group 2 Paragraph

Secondary Diagnoses

Group 2 Codes

Code	Description
Z68.1	Body mass index [BMI] 19.9 or less, adult
Z68.20	Body mass index [BMI] 20.0-20.9, adult
Z68.21	Body mass index [BMI] 21.0-21.9, adult
Z68.22	Body mass index [BMI] 22.0-22.9, adult
Z68.23	Body mass index [BMI] 23.0-23.9, adult
Z68.24	Body mass index [BMI] 24.0-24.9, adult
Z68.25	Body mass index [BMI] 25.0-25.9, adult
Z68.26	Body mass index [BMI] 26.0-26.9, adult
Z68.27	Body mass index [BMI] 27.0-27.9, adult
Z68.28	Body mass index [BMI] 28.0-28.9, adult
Z68.29	Body mass index [BMI] 29.0-29.9, adult
Z68.30	Body mass index [BMI] 30.0-30.9, adult
Z68.31	Body mass index [BMI] 31.0-31.9, adult
Z68.32	Body mass index [BMI] 32.0-32.9, adult
Z68.33	Body mass index [BMI] 33.0-33.9, adult
Z68.34	Body mass index [BMI] 34.0-34.9, adult

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

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Group 1

(1 Code)

Group 1 Paragraph

All those not listed under the "ICD-10 Codes that are Covered" section of this article.

Group 1 Codes

Code	Description
XX000	Not Applicable

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.

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

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

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
01/01/2022	R3	Based on the annual CPT/HCPCS update, CPT codes 64568 and 0466T have been replaced with CPT code 64582, and CPT codes 0467T and 0468T have been replaced with CPT codes 64583 and 64584. Modifier 52 has been added to the CPT/HCPCS Modifiers section of the article.
10/01/2021	R2	Based on the annual ICD-10 code update, the descriptor has changed for ICD-10 code Z68.30 in Group 2.
10/01/2020	R1	Based on the annual ICD-10 code update, the descriptor has changed for ICD-10 codes Z68.1, Z68.20, Z68.21, Z68.22, Z68.23, Z68.24, Z68.25, Z68.26, Z68.27, Z68.28, Z68.29, Z68.30, Z68.31, Z68.32, Z68.33 and Z68.34 in Group 2.

Associated Documents

Related Local Coverage Documents
LCDs
L38387 - Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Updated On	Effective Dates	Status
12/22/2021	01/01/2022 - N/A	Currently in Effect	You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea

Document Note

Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

Revenue Codes

CPT/HCPCS Codes

Group 1

CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 2

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

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

Revenue Codes

Other Coding Information

Group 1

Coding Table Information

Revision History Information

Associated Documents

Keywords

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