Local Coverage Article Billing and Coding

Billing and Coding: Spinal Cord Stimulation for Chronic Pain

A57709

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General Information

Article ID
A57709
Article Title
Billing and Coding: Spinal Cord Stimulation for Chronic Pain
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
N/A
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.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L36035 Spinal Cord Stimulation for Chronic Pain provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in the LCD. 

Coding Guidelines

CPT codes 63650, 63655, and 63661-63664 describe the operative placement, revision, replacement, or removal of the spinal neurostimulator system components to provide spinal electrical stimulation.

CPT codes 63650, 63661, and 63663 describe a percutaneously placed neurostimulator system. The contacts are on a catheter-like lead. An array defines the collection of contacts that are on one catheter.

CPT codes 63655, 63662, and 63664 are for neurostimulator system placed via an open surgical exposure. The contacts are on a plate or paddle-shaped surface.

Do not report CPT code 63661 when removing the percutaneous trial electrode (CPT code 63650). The work of removing a temporary percutaneous lead array is valued within the code for the “initial” placement.

CPT code 63663 (revision of a percutaneously implanted system) would only be used if a previous permanent (internalized system) array of neurostimulator electrodes had been percutaneously placed, and is now being revised or replaced to improve efficacy.

CPT code 63650 is not altered when the implantation of the percutaneous epidural neurostimulator electrode is performed for the purpose of a "temporary" trial or for "permanent" neurostimulation. The difference between the two procedures is the attachment of the electrode array to an external stimulator unit for trial stimulation as opposed to connecting to an implanted pulse generator or receiver for permanent stimulation. Attachment to an external stimulator unit is considered inherent to the work represented by CPT code 63650. Therefore, it is not appropriate to report CPT code 63685.

CPT code 63685 would be reported in addition to CPT code 63650, for the insertion or replacement of the pulse generator or receiver. CPT code 63685 includes the creation of a subcutaneous pocket made to house the stimulator and tunneling of the electrodes to the pocket.

Append modifier 58, Staged or Related Procedure or Service by the Same Physician During the Postoperative Period, to permanent implant insertion (CPT codes 63650 or 63655) if performed during the postoperative period of the initial (temporary) percutaneous electrode insertion (CPT code 63650).

The fluoroscopic guidance (e.g., CPT codes 76000, 77003) is considered inherent in the performance of the percutaneous implantation of the neurostimulator electrode array in the epidural space, as represented by CPT code 63650. Therefore, it would not be appropriate to additionally report the fluoroscopic guidance used.

CPT code 95970 describes electronic analysis of a simple or complex brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming. 

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.
  4. The medical records must support the patient has chronic intractable pain unresponsive to adequate pain control and the rationale for proceeding to permanent implant. In addition, documentation should include the severity of pain experienced by the patient, previous treatments and their outcomes, as well as the patient’s neurological condition and general state of health.
  5. Documentation must include evidence to support a successful trial was performed with at least a 50% reduction of target pain, or 50% reduction of analgesic medications, and should show some element of functional improvement. 

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice. 

Compliance with the provisions in LCD L36035, Spinal Cord Stimulation for Chronic Pain may be monitored and addressed through post payment data analysis and subsequent medical review audits.

Coding Information

CPT/HCPCS Codes

Group 1

(8 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
63661 REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
63662 REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
63663 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
63664 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
63685 INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING
63688 REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER

Group 2

Group 2 Paragraph

The following CPT codes associated with the services outlined in this LCD will not have diagnosis to procedure code limitations applied at this time: 95970, 95971, and 95972

Group 2 Codes

N/A

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(239 Codes)
Group 1 Paragraph

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 63650, 63655, 63661, 63662, 63663, 63664, 63685, and 63688.

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.

Group 1 Codes
CodeDescription
B02.0 Zoster encephalitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.29 Other postherpetic nervous system involvement
G03.0 Nonpyogenic meningitis
G03.1 Chronic meningitis
G03.8 Meningitis due to other specified causes
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
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
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
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
M96.1 Postlaminectomy syndrome, not elsewhere classified
S14.101S Unspecified injury at C1 level of cervical spinal cord, sequela
S14.102S Unspecified injury at C2 level of cervical spinal cord, sequela
S14.103S Unspecified injury at C3 level of cervical spinal cord, sequela
S14.104S Unspecified injury at C4 level of cervical spinal cord, sequela
S14.105S Unspecified injury at C5 level of cervical spinal cord, sequela
S14.106S Unspecified injury at C6 level of cervical spinal cord, sequela
S14.107S Unspecified injury at C7 level of cervical spinal cord, sequela
S14.108S Unspecified injury at C8 level of cervical spinal cord, sequela
S14.111S Complete lesion at C1 level of cervical spinal cord, sequela
S14.112S Complete lesion at C2 level of cervical spinal cord, sequela
S14.113S Complete lesion at C3 level of cervical spinal cord, sequela
S14.114S Complete lesion at C4 level of cervical spinal cord, sequela
S14.115S Complete lesion at C5 level of cervical spinal cord, sequela
S14.116S Complete lesion at C6 level of cervical spinal cord, sequela
S14.117S Complete lesion at C7 level of cervical spinal cord, sequela
S14.118S Complete lesion at C8 level of cervical spinal cord, sequela
S14.121S Central cord syndrome at C1 level of cervical spinal cord, sequela
S14.122S Central cord syndrome at C2 level of cervical spinal cord, sequela
S14.123S Central cord syndrome at C3 level of cervical spinal cord, sequela
S14.124S Central cord syndrome at C4 level of cervical spinal cord, sequela
S14.125S Central cord syndrome at C5 level of cervical spinal cord, sequela
S14.126S Central cord syndrome at C6 level of cervical spinal cord, sequela
S14.127S Central cord syndrome at C7 level of cervical spinal cord, sequela
S14.128S Central cord syndrome at C8 level of cervical spinal cord, sequela
S14.131S Anterior cord syndrome at C1 level of cervical spinal cord, sequela
S14.132S Anterior cord syndrome at C2 level of cervical spinal cord, sequela
S14.133S Anterior cord syndrome at C3 level of cervical spinal cord, sequela
S14.134S Anterior cord syndrome at C4 level of cervical spinal cord, sequela
S14.135S Anterior cord syndrome at C5 level of cervical spinal cord, sequela
S14.136S Anterior cord syndrome at C6 level of cervical spinal cord, sequela
S14.137S Anterior cord syndrome at C7 level of cervical spinal cord, sequela
S14.138S Anterior cord syndrome at C8 level of cervical spinal cord, sequela
S14.151S Other incomplete lesion at C1 level of cervical spinal cord, sequela
S14.152S Other incomplete lesion at C2 level of cervical spinal cord, sequela
S14.153S Other incomplete lesion at C3 level of cervical spinal cord, sequela
S14.154S Other incomplete lesion at C4 level of cervical spinal cord, sequela
S14.155S Other incomplete lesion at C5 level of cervical spinal cord, sequela
S14.156S Other incomplete lesion at C6 level of cervical spinal cord, sequela
S14.157S Other incomplete lesion at C7 level of cervical spinal cord, sequela
S14.158S Other incomplete lesion at C8 level of cervical spinal cord, sequela
S24.101S Unspecified injury at T1 level of thoracic spinal cord, sequela
S24.102S Unspecified injury at T2-T6 level of thoracic spinal cord, sequela
S24.103S Unspecified injury at T7-T10 level of thoracic spinal cord, sequela
S24.104S Unspecified injury at T11-T12 level of thoracic spinal cord, sequela
S24.111S Complete lesion at T1 level of thoracic spinal cord, sequela
S24.112S Complete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.113S Complete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.114S Complete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.131S Anterior cord syndrome at T1 level of thoracic spinal cord, sequela
S24.132S Anterior cord syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.133S Anterior cord syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.134S Anterior cord syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.151S Other incomplete lesion at T1 level of thoracic spinal cord, sequela
S24.152S Other incomplete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.153S Other incomplete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.154S Other incomplete lesion at T11-T12 level of thoracic spinal cord, sequela
S34.101S Unspecified injury to L1 level of lumbar spinal cord, sequela
S34.102S Unspecified injury to L2 level of lumbar spinal cord, sequela
S34.103S Unspecified injury to L3 level of lumbar spinal cord, sequela
S34.104S Unspecified injury to L4 level of lumbar spinal cord, sequela
S34.105S Unspecified injury to L5 level of lumbar spinal cord, sequela
S34.111S Complete lesion of L1 level of lumbar spinal cord, sequela
S34.112S Complete lesion of L2 level of lumbar spinal cord, sequela
S34.113S Complete lesion of L3 level of lumbar spinal cord, sequela
S34.114S Complete lesion of L4 level of lumbar spinal cord, sequela
S34.115S Complete lesion of L5 level of lumbar spinal cord, sequela
S34.121S Incomplete lesion of L1 level of lumbar spinal cord, sequela
S34.122S Incomplete lesion of L2 level of lumbar spinal cord, sequela
S34.123S Incomplete lesion of L3 level of lumbar spinal cord, sequela
S34.124S Incomplete lesion of L4 level of lumbar spinal cord, sequela
S34.125S Incomplete lesion of L5 level of lumbar spinal cord, sequela
S34.131S Complete lesion of sacral spinal cord, sequela
S34.132S Incomplete lesion of sacral spinal cord, sequela
S34.139S Unspecified injury to sacral spinal cord, sequela
S34.3XXS Injury of cauda equina, sequela
T85.01XA* Breakdown (mechanical) of ventricular intracranial (communicating) shunt, initial encounter
T85.01XD* Breakdown (mechanical) of ventricular intracranial (communicating) shunt, subsequent encounter
T85.01XS* Breakdown (mechanical) of ventricular intracranial (communicating) shunt, sequela
T85.02XA* Displacement of ventricular intracranial (communicating) shunt, initial encounter
T85.02XD* Displacement of ventricular intracranial (communicating) shunt, subsequent encounter
T85.02XS* Displacement of ventricular intracranial (communicating) shunt, sequela
T85.03XA* Leakage of ventricular intracranial (communicating) shunt, initial encounter
T85.03XD* Leakage of ventricular intracranial (communicating) shunt, subsequent encounter
T85.03XS* Leakage of ventricular intracranial (communicating) shunt, sequela
T85.09XA* Other mechanical complication of ventricular intracranial (communicating) shunt, initial encounter
T85.09XD* Other mechanical complication of ventricular intracranial (communicating) shunt, subsequent encounter
T85.09XS* Other mechanical complication of ventricular intracranial (communicating) shunt, sequela
T85.110A* Breakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), initial encounter
T85.110D* Breakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), subsequent encounter
T85.110S* Breakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), sequela
T85.111A* Breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter
T85.111D* Breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), subsequent encounter
T85.111S* Breakdown (mechanical) of implanted electronic neurostimulator of peripheral nerve electrode (lead), sequela
T85.112A* Breakdown (mechanical) of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter
T85.112D* Breakdown (mechanical) of implanted electronic neurostimulator of spinal cord electrode (lead), subsequent encounter
T85.112S* Breakdown (mechanical) of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.113A* Breakdown (mechanical) of implanted electronic neurostimulator, generator, initial encounter
T85.113D* Breakdown (mechanical) of implanted electronic neurostimulator, generator, subsequent encounter
T85.113S* Breakdown (mechanical) of implanted electronic neurostimulator, generator, sequela
T85.118A* Breakdown (mechanical) of other implanted electronic stimulator of nervous system, initial encounter
T85.118D* Breakdown (mechanical) of other implanted electronic stimulator of nervous system, subsequent encounter
T85.118S* Breakdown (mechanical) of other implanted electronic stimulator of nervous system, sequela
T85.120A* Displacement of implanted electronic neurostimulator of brain electrode (lead), initial encounter
T85.120D* Displacement of implanted electronic neurostimulator of brain electrode (lead), subsequent encounter
T85.120S* Displacement of implanted electronic neurostimulator of brain electrode (lead), sequela
T85.121A* Displacement of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter
T85.121D* Displacement of implanted electronic neurostimulator of peripheral nerve electrode (lead), subsequent encounter
T85.121S* Displacement of implanted electronic neurostimulator of peripheral nerve electrode (lead), sequela
T85.122A* Displacement of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter
T85.122D* Displacement of implanted electronic neurostimulator of spinal cord electrode (lead), subsequent encounter
T85.122S* Displacement of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.123A* Displacement of implanted electronic neurostimulator, generator, initial encounter
T85.123D* Displacement of implanted electronic neurostimulator, generator, subsequent encounter
T85.123S* Displacement of implanted electronic neurostimulator, generator, sequela
T85.128A* Displacement of other implanted electronic stimulator of nervous system, initial encounter
T85.128D* Displacement of other implanted electronic stimulator of nervous system, subsequent encounter
T85.128S* Displacement of other implanted electronic stimulator of nervous system, sequela
T85.190A* Other mechanical complication of implanted electronic neurostimulator of brain electrode (lead), initial encounter
T85.190D* Other mechanical complication of implanted electronic neurostimulator of brain electrode (lead), subsequent encounter
T85.190S* Other mechanical complication of implanted electronic neurostimulator of brain electrode (lead), sequela
T85.191A* Other mechanical complication of implanted electronic neurostimulator of peripheral nerve electrode (lead), initial encounter
T85.191D* Other mechanical complication of implanted electronic neurostimulator of peripheral nerve electrode (lead), subsequent encounter
T85.191S* Other mechanical complication of implanted electronic neurostimulator of peripheral nerve electrode (lead), sequela
T85.192A* Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), initial encounter
T85.192D* Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), subsequent encounter
T85.192S* Other mechanical complication of implanted electronic neurostimulator of spinal cord electrode (lead), sequela
T85.193A* Other mechanical complication of implanted electronic neurostimulator, generator, initial encounter
T85.193D* Other mechanical complication of implanted electronic neurostimulator, generator, subsequent encounter
T85.193S* Other mechanical complication of implanted electronic neurostimulator, generator, sequela
T85.199A* Other mechanical complication of other implanted electronic stimulator of nervous system, initial encounter
T85.199D* Other mechanical complication of other implanted electronic stimulator of nervous system, subsequent encounter
T85.199S* Other mechanical complication of other implanted electronic stimulator of nervous system, sequela
T85.79XA* Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter
T85.79XD* Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.79XS* Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, sequela
T85.810A* Embolism due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.810D* Embolism due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.810S* Embolism due to nervous system prosthetic devices, implants and grafts, sequela
T85.818A* Embolism due to other internal prosthetic devices, implants and grafts, initial encounter
T85.818D* Embolism due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.818S* Embolism due to other internal prosthetic devices, implants and grafts, sequela
T85.820A* Fibrosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.820D* Fibrosis due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.820S* Fibrosis due to nervous system prosthetic devices, implants and grafts, sequela
T85.828A* Fibrosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.828D* Fibrosis due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.828S* Fibrosis due to other internal prosthetic devices, implants and grafts, sequela
T85.830A* Hemorrhage due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.830D* Hemorrhage due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.830S* Hemorrhage due to nervous system prosthetic devices, implants and grafts, sequela
T85.838A* Hemorrhage due to other internal prosthetic devices, implants and grafts, initial encounter
T85.838D* Hemorrhage due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.838S* Hemorrhage due to other internal prosthetic devices, implants and grafts, sequela
T85.840A* Pain due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.840D* Pain due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.840S* Pain due to nervous system prosthetic devices, implants and grafts, sequela
T85.848A* Pain due to other internal prosthetic devices, implants and grafts, initial encounter
T85.848D* Pain due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.848S* Pain due to other internal prosthetic devices, implants and grafts, sequela
T85.850A* Stenosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.850D* Stenosis due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.850S* Stenosis due to nervous system prosthetic devices, implants and grafts, sequela
T85.858A* Stenosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.858D* Stenosis due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.858S* Stenosis due to other internal prosthetic devices, implants and grafts, sequela
T85.860A* Thrombosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.860D* Thrombosis due to nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.860S* Thrombosis due to nervous system prosthetic devices, implants and grafts, sequela
T85.868A* Thrombosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.868D* Thrombosis due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.868S* Thrombosis due to other internal prosthetic devices, implants and grafts, sequela
T85.890A* Other specified complication of nervous system prosthetic devices, implants and grafts, initial encounter
T85.890D* Other specified complication of nervous system prosthetic devices, implants and grafts, subsequent encounter
T85.890S* Other specified complication of nervous system prosthetic devices, implants and grafts, sequela
T85.898A* Other specified complication of other internal prosthetic devices, implants and grafts, initial encounter
T85.898D* Other specified complication of other internal prosthetic devices, implants and grafts, subsequent encounter
T85.898S* Other specified complication of other internal prosthetic devices, implants and grafts, sequela
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*The additional ICD-10-CM diagnosis codes listed above with asterisks only apply to CPT codes 63661, 63662, 63663, 63664, 63685, and 63688.

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

Group 1

(1 Code)
Group 1 Paragraph

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

Group 1 Codes
CodeDescription
XX000 Not Applicable

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
999x Not Applicable

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.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

N/A

Associated Documents

Related Local Coverage Documents
LCDs
L36035 - Spinal Cord Stimulation for Chronic Pain
Related National Coverage Documents
NCDs
160.7 - Electrical Nerve Stimulators
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
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Public Versions
Updated On Effective Dates Status
11/21/2019 10/03/2018 - N/A Currently in Effect You are here

Keywords

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